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Surgical treatment for advanced gastric cancer
1Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Background/Aims:
We herein report on the clinicopathological factors related to the unresectability of far advanced gastric cancer and the prognostic effect of gastrectomy on these cases.
Material And Methods:
There are four main prognostic factors for advanced gastric cancer including 1) peritoneal dissemination, 2) hepatic metastasis, 3) lymph node involvement and 4) invasion to adjacent organs.
Results:
The rate of unresectability was high in the cases demonstrating both histologically undifferentiated type cancer and cancers located in the lower third of the stomach. It was difficult to resect the main tumor based on an increase in the factors regulating the macroscopical stage. The rate of unresectability tended to be higher in cancers with peritoneal dissemination or invasion to adjacent organs. The pancreas was the most frequently invaded organ. accounting for the unresectability of the disease. The prognosis for cases with unresected gastric cancers was poor and all died within 2 years of the operation. In addition, the prognosis for cases with Stage IV gastric cancer, demonstrating either 1 or 2 factors, improved after gastrectomy while no such improvement was seen in cases with 3 or 4 factors.
Conclusions:
To improve prognosis, gastrectomy should be performed when a patient has far advanced gastric cancer but only demonstrates 1 or 2 of the above 4 factors.