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World J Gastroenterol. Nov 28, 2005; 11(44): 7014-7017
Published online Nov 28, 2005. doi: 10.3748/wjg.v11.i44.7014
Treatment for isolated loco-regional recurrence of gastric adenocarcinoma: Does surgery play a role?
Fabio Carboni, Pasquale Lepiane, Roberto Santoro, Riccardo Lorusso, Pietro Mancini, Massimo Carlini, Eugenio Santoro
Fabio Carboni, Pasquale Lepiane, Roberto Santoro, Riccardo Lorusso, Pietro Mancini, Eugenio Santoro, Department of Digestive Surgery and Liver Transplantation, Regina Elena Cancer Institute, Rome, Italy
Massimo Carlini, Division of General A.T. Surgery, St. Eugenio Hospital, Rome, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Fabio Carboni, MD, PhD, Department of Digestive Surgery and Liver Transplantation, Regina Elena Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy. fabiocarb@tiscali.it
Telephone: +39-6-52666789 Fax: +39-6-52662338
Received: January 14, 2005
Revised: April 23, 2005
Accepted: April 26, 2005
Published online: November 28, 2005
Abstract

AIM: To evaluate the role of surgical treatment for isolated loco-regional recurrences of operated gastric adenocarcinoma.

METHODS: Among the 837 patients operated for gastric adenocarcinoma between December 1979 and April 2004, 713 (85%) underwent resection with curative intent. A retrospective review of a prospectively collected gastric cancer database was carried out. Overall recurrence rate was 44% (315 cases), with 75% occurring within the first 2 years from the operation. Isolated L-R recurrences were observed in 38 (12%) patients. Symptomatic lesions were observed in 27 (71%).

RESULTS: Six (16%) patients were macroscopically resected with curative intent. The recurrence was located in the gastric stump after a STG in three patients, in the esophagojejunal anastomosis after a TG in two patients and in the gastric bed after a TG in one patient. Surgical procedures consisted of three secondary TG, two esophagojejunal resection and one excision of an extraluminal recurrence. Postoperative complications occurred in two patients (33%), including one anastomotic leakage and one hemorrhage. The latter patient died of sepsis 35 d after the surgery (mortality rate 17%). All patients died of recurrent gastric cancer: 2 within 1 year from surgery (8 and 11 mo, respectively), 2 after 16 and 17 mo respectively and 1 after 28 mo from the second operation.

CONCLUSION: Surgery plays a very limited role in the treatment for isolated loco-regional recurrence of gastric adenocarcinoma.

Keywords: Gastric adenocarcinoma; Recurrence; Diagnosis; Surgery