Rationale of reoperation for gastric malignancies

The aim of this retrospective study was to elucidate the role and rationale of reoperation for tumour recurrence in 47 consecutive patients operated on for gastric cancer. The overall operative mortality was 26%, morbidity 45%, mean and median survivals 14 +/- 25 and 5 months, respectively postoperative symptom free period 8 +/- 23 months, and cumulative 5-year survival 8 +/- 3%. Bypass procedures and resection carried the lowest mortality, 7% and 20%, respectively whereas the corresponding percentages after colostomy, exploratory laparotomy and jejunostomy were 33%, 40% and 50%. Resection yielded a significantly longer mean (41 +/- 44 mos) and median (82 mos) survival than other procedures. The postoperative symptom free period after resection (34 +/- 42 mos) was significantly longer than after exploratory laparotomy and bypass procedures, whereas the difference between resection and enterostomy was insignificant. After exploratory laparotomy, colo- and jejunostomy the median survivals were under 2 months. We conclude that only resection, when possible, favourably affects survival and emphasize the importance of regular endoscopic follow-up after operation for gastric cancer. Resection and bypass procedures are most suitable for long-lasting palliation at reoperation for gastric malignancy. Unnecessary laparotomies, if the diagnosis can be confirmed by other means, and useless jejunostomies should be avoided in patients with far-advanced metastatic disease and short life expectancy.