RADICAL TREATMENT OF LOCALLY RECURRENT GASTRIC-CANCER

Locally recurrent gastric cancer develops in 45 per cent of resected p atients. This study assessed the impact of an aggressive search for re currence after radical operations and the use of reoperative and adjuv ant therapy in this setting. From 1983 to 1990, 75 patients were explo red for regionally recurrent gastric cancer. Resection was possible in 40 (53.5%), and palliative bypass was possible in 19 (25.3%); explora tion only was performed in 16 (21.4%). Among resectable patients, gast rectomy was performed in 22 (55%) and gastrectomy with adjacent organ resection in 18 (45%) with an overall operative mortality of 15% (6 pa tients). Mean duration of life after bypass was 3.1 months; after expl oration 4.5 months. Fifteen (40.6%) were not candidates for radiation or chemotherapy, 13 (31.2%) received preoperative radiotherapy (20 Gy) , and 12 (28.2%) received postoperative systemic chemotherapy. Two-yea r survival after radical treatment was as follows: surgery alone 20%; radiotherapy and surgery 31.3%; surgery and chemotherapy 66.4%. These preliminary results indicate that re-excision benefits selected patien ts with recurrent gastric cancer. Patients receiving radiotherapy and chemotherapy tended toward improved survival.