Clinical Characteristics Of Recurrence After Curative Gastrectomy For Gastirc Cancer And Effect Analysis For Reoperation

Background:Gastric cancer is one of the common gastrointestinal cancer,the mortalityrate was about152/100000population ranked second after liver cancer.gastric cancer can be divided into simple and advanced gastric cancer. Earlygastric cancer refers to tumors confined to the mucosa or submucosa, regardlessof lymph node metastasis[1].Although the prognosis of early gastric cancer iswell, but the detection rate of early gastric cancer accounts for about5%of thedomestic, Jixian Shan and other reported11cases of recurrence in109cases ofearly gastric cancer, the recurrence rate was10.1%.In China, More than70%ofpatients were already advanced gastric cancer in treatment[2], and the recurrenceof advanced gastric cancer after radical surgery was50%-70%[3,4]. In contrast,the recurrence rate of early gastric cancer was significantly lower than that ofadvanced gastric cancer. Therefore, the popularity of related knowledge aboutgastric cancer, strengthening to screen from high-risk patients in gastric cancer,early diagnosis and early treatment will reduce the root causes of recurrencerate of gastric cancer. For advanced gastric cancer, surgery is the only possibleway to cure the disease. But there are still more than60%of patients afterrecurrence, seriously affecting the patient’s quality of living and the life.Because of the low resection rate and the more postoperative complicationsabout recurrence of gastric cancer, and with these patients being mostly withinone year, the traditional chemotherapy or combination chemotherapy is not satisfied,therefore,there is no standard treatment on recurrence of gastric cancer.With the continuous development technology of gastric cancer’s treatment,treatment about recurrence of gastric cancer is no longer limited to simple orcombined chemotherapy, but surgery or neoadjuvant chemotherapy unitingsurgery is apply to the treatment about recurrence of gastric cancer well, it laida theoretical foundation for the normative treatment about recurrence of gastriccancer.Objective:To investigate the clinical characteristics of recurrence after curativegastrectomy for gastric cancer; investigate the prognostic factors of recurrent ofgastric cancer; analysis recurrence after curative gastrectomy for gastric canceragain whether radical surgery can improve the quality of life of patients andimprove long-term survival.Methods:A retrospective analysis of the clinical data of patients with recurrenceafter curative gastrectomy for gastric cancer in our hospital in the period fromMarch2005to September2011, during hospitalization the patients underwentone or more of these examination of total abdominal CT or enhanced CT, PET,abdominal ultrasonography, endoscopy and biopsy, gastrointestinal tumormarkers, laparoscopy or laparotomy. to determine the best treatment modalityneed Preoperative assessment and multi-disciplinary system. survival time thatis from diagnosed time of the recurrence to follow-up deadline or death time by means of telephone follow-up after leaving hospital for patients with recurrentof gastric cancer. Statistical information and observe prognosis of postoperativeand the effectiveness of surgery. Relevant data were statistically analyzed usingSPSS19.0software.Results:Among62patients relapsed after surgery in this group of patients,therewere17patients (27.42%) relapse in the first year after surgery,18cases(29.03%) relapse in the second year;17patients (27.42%)in the third year,7cases (11.30%) relapse in fifth year,and only three cases (4.83%) sufferingfrom recurrence over five years.It was17patients (27.42%) which waslocated on Gastric remnant、the surgical field local recurrence stove (includingrecurrence with gastrointestinal anastomotic or residual stomach, a singlelymph node or cancer nodules, limitations relapse with adjacent organs),37cases (59.68%) of peritoneal recurrence;10cases (16.13%) of haematogen-ous recurrence. In all relapsed patients, there were28patients suffering fromreoperation, eight cases (28.57%) of which underwent radical surgery. Bohneret al[5]pointed out that only21%of patients was suitable for radical surgery inthe patients with recurrence after curative gastrectomy for gastric cancer.recurrence of gastric cancer was mainly in the peritoneal recurrence occurringmostly in two years, and after then leveling off, the longer is recurrence-freeperiod, the greater is possibility of radical surgery again. Age, whetherchemotherapy,recurrence type, recurrence-free period, CA72-4, the way of reoperation are prognostic factors for recurrent of gastric cancer. For wellphysical condition, well heart and lung function, and no distant metastases andextensive,local recurrence and isolated resectable lesions, or complicationssuch as obstruction and bleeding, surgical treatment can be used as the firsttreatment,which can provide time and accordance for the next comprehensivetreatment and significantly improving the quality of life of patients and prolongsurvival.Conclusion:1. recurrence of gastric cancer was mainly in the peritoneal recurrenceoccurring mostly in two years, the longer is recurrence-free period, thegreater is possibility of radical surgery again.2. Age, whether chemotherapy,recurrence type, recurrence-free period,CA72-4, the way of reoperation are prognostic factors for recurrent of gastriccancer.3. If patients for recurrence with curative gastrectomy for gastric cancerwere appropriate for surgery, surgery can significantly improve the patients’quality of life and prolong survival time.survival with reoperation wassignificantly longer than non-surgical patients, and long-term survival withradical surgery is far better than non-radical surgery patients.