P-102 - Results of surgical therapy for loco-regional recurrence of gastric cancer

Abstract

Introduction

Gastric cancer (GC) remains still one of the major cause of cancer death worldwide. Surgery is the main effective treatment; alternative methods rare have reliable effect. GC recurrence is still often the cause of unsuccessful recovery. A research objective is to determine outcome of surgery for GC recurrence.

Methods

There were analysed data of 35 patients submitted surgery for GC recurrence at Herzen Moscow Cancer Research Institute in 2000-2013. Among this 8 underwent curative resection of primary GC at our Institute, 27 - in other hospitals of Russia. Thus 6 patients had recurrence after proximal subtotal, 17 – after distal subtotal gastrectomy, 12 – after a total gastrectomy. Twenty-six patients had isolated loco-regional recurrence, 3 – solitary distance metastasis, 6 – advanced recurrences. In our series 50% of primary GC have staged IIIA-B and IV (in one patient GC was stage IV with mesenterial lymph node metastasis; at another – lymph node metastasis of a.colica media) (TNM 7ed). Time interval to recurrence, recurrence pattern, type of surgery, survival and postoperative outcome were analysed.

Results

The average time to recurrence in the group was 22,9 ± 3,4 months. GC recurrence was located in anastomosis and gastric stump at 25 patients, 7 patients had loco-regional extraluminal recurrence, 3 patients distant solitary metachronous metastasis. In total 33 operations were performed: 12 - extirpation of gastric stump, 8 - resection esophagojejunal anastomosis (after a total gastrectomy); 2- stomach reresection after distal gastrectomy; 8 - removal of extraluminal recurrence; 3 - removal of solitary metastasises. Complete (R0) resection was performed at 66,7% (22 operations), incomplete R1 – 27,3% (9), R2 - 6,06% (2). All operations were followed by an extended lymphadenectomy. The combined resection (involved organs - pancreas, adrenal gland, mesocolon, splenectomy) was performed in 9 patients. The thoracoabdominal approaches were applied at 10 operations (30%): 8 – a laparotomy and right thoracotomy, 1 – left thoracoabdominal, at 1 - abdomino-transhiatal approach with esophagectomy. Esophageal reconstructions were performed at 11 (33,3%): jejunum segment - 9, colon graft – 2. Distant solitary metachronous metastasis resection was carried out at 4 cases. Postoperative complications occurred in 15 patients (45,5%), including I grade complication (Clavien-Dindo) at 3 patients, grade II – at 5, IIIA-2 and IIIB-2; IV – at 2 patients; grade V (death from postoperative complications) – 1 patient. Anastomotic leakages were observed at 4 patients (one patient of them died). A postoperative morbidity was 3%. Follow-up information was obtained at 32 patients: one-year survival was 44%, 3-year – 25%; 5-year survival was noted at 1 patient (2,8%), p = 0,08.

Conclusion

Surgical method has limited application at treatment of GC recurrence, surgical therapy seems to be effective at isolated loco-regional GC recurrence and thus improves survival rate