Department of Gastrointestinal Surgery, Cancer Institute Ariake Hospital, Tokyo, Japan.
Langenbecks Arch Surg. 2011 Feb;396(2):161-6. doi: 10.1007/s00423-010-0730-2. Epub 2010 Dec 14.
Locoregional recurrent gastric cancer is commonly treated by systemic chemotherapy. The effectiveness of surgical treatment, in terms of complete tumor resection, is unknown.
We reviewed the case histories of 36 patients with locoregional recurrent gastric cancer, selected for surgical treatment by careful preoperative assessment. Patient characteristics and survival data were collected and analyzed. Prognostic factors were also assessed by univariate analysis using the log-rank test.
Among 36 patients with recurrent gastric tumors, including 18 patients with local recurrences and 18 patients with single-regional lymph node recurrences, the average time to recurrence after initial surgery was 26.4 ± 2.8 months. Complete resection was possible in 29 patients (80.6%), with incomplete resection in the remaining seven patients (19.4%). Various types of surgery were used for tumor recurrence; 23 patients (63.9%) underwent procedures to resect the tumor and the affected organs. The median survival time (median ± standard error) was 23.0 ± 2.8 months, and overall 1-, 3-, and 5-year survival rates were 73.0%, 36.7%, and 9.8%, respectively. Complete resectability of the tumor was the only significant prognostic factor identified.
Although there was no control group in the present study with similarly limited tumor recurrence and treated solely with modern systemic chemotherapy, such a study population would be too small to conduct a randomized study in. For those patients for whom surgery is indicated by multidisciplinary assessment, surgical resection can be applied for recurrent lesions if complete resection can be accomplished with low perioperative risk for the extended surgery.
局部复发性胃癌通常采用全身化疗治疗。手术治疗的效果（即完全肿瘤切除）尚不清楚。
我们回顾了 36 例局部复发性胃癌患者的病史，这些患者经仔细的术前评估选择手术治疗。收集并分析了患者特征和生存数据。通过对数秩检验的单因素分析评估了预后因素。
在 36 例复发性胃肿瘤患者中，包括 18 例局部复发和 18 例单一区域淋巴结复发患者，首次手术后复发的平均时间为 26.4 ± 2.8 个月。29 例患者（80.6%）可完全切除肿瘤，其余 7 例（19.4%）不完全切除肿瘤。对于肿瘤复发，使用了各种类型的手术；23 例患者（63.9%）进行了切除肿瘤和受影响器官的手术。中位生存时间（中位数±标准误差）为 23.0 ± 2.8 个月，总 1 年、3 年和 5 年生存率分别为 73.0%、36.7%和 9.8%。肿瘤的完全可切除性是唯一确定的显著预后因素。
尽管本研究没有对照组，且肿瘤复发限制在同样的范围内，仅采用现代全身化疗治疗，但这样的研究人群太小，无法进行随机研究。对于那些经多学科评估认为手术指征明确的患者，如果能够完成完整的肿瘤切除且扩大手术的围手术期风险较低，则可以对复发病灶进行手术切除。
