근치적 수술 후 재발한 위암 환자의 임상 병리학적 분석

Abstract

Purpose: Despite radical lymph node dissections and combined resections, experiences of recurrent gastric carcinomas are not infrequent. The prognosis of a recurrent gastric carcinoma has not improved despite the considerable recent progress in their treatment. This study was designed to investigate the correlation between the clinicopathological characteristics and recurrence patterns in gastric cancer following a curative resection. Methods: The medical records of 1,163 patients, who had undergone curative resection for primary gastric cancer, in Department of Surgery, Keimyung University School of Medicine, between January 1990 and December 1996, were retrospectively reviewed. The clinicopathological characteristics, relationship of each factor with the pattern of recurrence and the rate of recurrence were analyzed. Results: Recurrent gastric cancer was confirmed in 350 patients (30.09%). The mean time interval to recurrence was 20.41±15.94 months. Of the patients with a recurrence, 231 (66.0%), 109 (31.1%) and 10 (2.9%) were early (0∼2 years), intermediate (2∼5 years) and late (more than 5 years) recurrences, respectively. 180 (51.4%), 90 (25.7%), 51 (14.6%) and 29 (8.3%) were peritoneal, loco-regional, distant and mixed recurrences, respectively. The recurrence patterns after a curative resection for a gastric carcinoma were related to the tumor location, differentiation, N-category and TNM stage. In a multivariate analysis, the size of tumor, Borrmann's classification, T-category, N-category, vascular invasion and Stage were found to be independent prognostic factors for a recurrence. Conclusion: Most recurrences of gastric carcinomas, following a curative resection, were found within 24 months. Therefore, the close follow up, with clinicopathological factors, is very important during this period, and might facilitate the early detection of a recurrence.