TUMOR RECURRENCE FOLLOWING RESECTION FOR EARLY GASTRIC-CARCINOMA AND ITS IMPLICATIONS FOR A POLICY OF LIMITED RESECTION

Some patients suffer postoperative recurrence after curative resection of early gastric carcinoma. This study reviewed consecutive patients with a single primary lesion and analyzed the relation between the pat hologic findings and recurrence of early gastric carcinomas for determ ining indications for limited surgery. Among the 1585 consecutive pati ents with a solitary primary lesion of an early gastric carcinoma who had undergone curative surgery between 1963 and 1989 at one general ho spital, pathologic findings relating to recurrence were analyzed accor ding to Japan's General Rules for Gastric Cancer Study in Surgery and pathology. Of these carcinomas, mucosal carcinomas comprised 701 (44.2 %) and submucosal ones 884 (55.8%). The total recurrence rate in this series was 1.0%, Submucosal carcinomas (1.6%) were significantly (p < 0.02) more recurrent than mucosal ones (0.29%), Of the 16 patients wit h recurrence, 10 (62.5%) died within 5 years after surgery, frequently because of blood-borne metastasis. Macroscopically elevated component s, the degree of histologic differentiation, and lymph node metastasis significantly contributed to the postoperative recurrence, After deta iled analysis of submucosal carcinomas, it is strongly suspected that carcinomas with a macroscopically elevated component were significantl y associated with nodal involvement and microvessel invasion, and that these abnormalities lead to recurrence. Among the early gastric carci nomas, differentiated submucosal carcinomas with a macroscopically ele vated component, lymph node metastasis, or both have the most potentia l of recurrence after surgery, Mucosal carcinomas must be restricted t o limited surgery, but, blood-borne metastasis should be carefully avo ided.