Surgical treatment for gastric leiomyosarcoma

Background: Gastric leiomyosarcoma is an uncommon disease, and the optimal treatment has not been established. In order to better define the optimal s urgical treatment, we retrospectively analyzed our experience with these tu mors. Methods: Records of 103 patients, who underwent surgery between 1972 and 19 97 were reviewed. Results: The upper third of stomach was the most frequent site of disease ( 66 cases). Seventy one tumors were smaller than 50 mm. Forty patients had u lcerated tumors. Twenty nine of 33 tumors had an inhomogeneous pattern on e ndoscopic ultrasonography. Nodal involvement was not observed in our series . The most common surgery was wedge resection, performed in 68 patients. Th e 5-year disease-specific survival rate after curative resection was 93.0 % overall, 87.5 % after gastrectomy, and 95.0 % after wedge resection. 5 yea r survival rate was worse in patients with ulcer than those without ulcer ( 87.1 % vs. 96.3 %, p < 0,01). No patient with a tumor smaller than 3 cm die d from the disease. The dominant mode of recurrence was liver and peritonea l metastasis. No lymph node recurrence was observed. Conclusions: Surgery is indicated for tumors larger than 3 cm, with rapid g rowth, with inhomogeneous US pattern, or with ulceration. Wedge resection i s the preferred treatment.