Recurrence following curative resection for gastric carcinoma

Background: The diagnosis and treatment of recurrent gastric cancer remains difficult. The aim of this study was to determine the risk factors for rec urrence of gastric cancer and the prognosis for these patients. Methods: Of 2328 patients who underwent curative resection for gastric canc er from 1987 to 1995, 508 whose recurrence was confirmed by clinical examin ation or reoperation were studied retrospectively. The risk factors that de termined the recurrence patterns and timing were investigated by univariate and multivariate analysis. Results: The mean time to recurrence was 21.8 months and peritoneal recurre nce was the most frequent (45.9 per cent). Logistic regression analysis sho wed that serosal invasion and lymph node metastasis were risk factors for a ll recurrence patterns and early recurrence (at 24 months or less). In addi tion, independent risk factors involved in each recurrence pattern included younger age, infiltrative or diffuse type, undifferentiated tumour and tot al gastrectomy for peritoneal recurrence; older age and larger tumour size for disseminated, haematogenous recurrence; and older age, larger tumour si ze, infiltrative or diffuse type, proximally located tumour and subtotal ga strectomy for locoregional recurrence. Other risk factors for early recurre nce were infiltrative or diffuse type and total gastrec-tomy. Reoperation f or cure was possible in only 19 patients and the mean survival time after c onservative treatment or palliative operation was less than 12 months. Conclusion: The risk factors for each recurrence pattern and timing of gast ric cancer can be predicted by the clinicopathological features of the prim ary tumour. Since the results of treatment remain dismal, studies of periop erative adjuvant therapy in an attempt to reduce recurrence are warranted.