PERITONEAL DISSEMINATION AFTER A CURATIVE GASTRECTOMY IN PATIENTS WITH UNDIFFERENTIATED ADENOCARCINOMA OF THE STOMACH

Peritoneal dissemination is the major pattern of recurrence in patient s with gastric cancer. Among the 1,337 patients with gastric cancer wh o underwent a curative resection, a multivariate analysis showed that the independent risk factors for the occurrence of peritoneal dissemin ation were an undifferentiated tissue type and serosal invasion. We fo cus our attention on 477 patients with undifferentiated type tumor, in which the postoperative prognosis and the pattern of recurrence after curative resection were evaluated with regard to the depth of the can cerous invasion in the gastric wall. Patients with tumors limiting to the subserosal layer had a satisfactory post-operative course, with fi ve-year survival rates of 98.5%, 97.4%, and 82.5% in patients with tum ors limiting to the submucosal layer, the muscularis propria and subse rosal layer, respectively. In 179 patients with tumors invading to the subserosal layer, however, the five year survival rate was only 48.2% . Seventy-one died of peritoneal dissemination, while 24 and 15 were d ue to hematogenous and local recurrences, respectively. Only 50 (27.9% ) survived over 5 years without any recurrence. (C) 1994 Wiley-Liss, I nc.