Skip to main content

Advertisement

SpringerLink
Log in

The efficacy of gastrectomy for large gastric cancer

  • ORIGINAL ARTICLE
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

Large gastric cancer (LGC) is frequently associated with extended disease, and the role of surgical resection has been debated. We investigated the efficacy of surgical treatment for LGC.

Methods

The size of LGC was defined as 8 cm or greater. Four hundred and fifteen patients with LGC who underwent gastrectomy were included. The clinicopathological features, the status of the residual tumor, the incidence and patterns of relapse, and the survival were analyzed.

Results

Macroscopically, diffuse-type tumors were dominant (60%). The numbers of patients with tumors of T3 or greater, lymph node involvement, and peritoneal metastases were 356 (86%), 359 (87%), and 126 (30%), respectively. One hundred and eighty-eight patients (45%) underwent incomplete tumor resection (R2). The R2/R0 (no residual tumor) ratio was greater than 1 in patients with type 4 tumors and N1 or greater metastasis and in those with type 3 tumors and N2 or greater metastasis. In contrast, T2, type 2, and type 5 tumors were more likely to be completely resected. The 5-year survival for all 415 patients was 26%. The survival rates were inversely related to the tumor type, size, and lymph node metastasis. In the 216 patients with R0, the 5-year survivals of those with pN (International Union Against Cancer [UICC] classification) 0, 1, 2, and 3 were 66%, 56%, 36%, and 5%, respectively (P = 0.001). In 96 of these 216 patients (44%) the tumor recurred, and peritoneal metastasis was the most frequent mode of recurrence (48%). By Cox's proportional hazard model, the tumor size was an independent prognostic factor.

Conclusion

The chance of achieving R0 resection for LGC is low, except for T2, type 2, or type 5 tumors. Primary resection should be avoided for other types of LGC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. K Maruyama K Okabayashi T Kinoshita (1987) ArticleTitleProgress in gastric cancer surgery in Japan and its limits of radicality World J Surg 11 418–425 Occurrence Handle10.1007/BF01655804 Occurrence Handle1:STN:280:BiiA387kt1w%3D Occurrence Handle3630186

    Article  CAS  PubMed  Google Scholar 

  2. F Roviello D Marrelli G Manzoni et al. (2003) ArticleTitleProspective study of peritoneal recurrence after curative surgery for gastric cancer Br J Surg 90 1113–1119 Occurrence Handle10.1002/bjs.4164 Occurrence Handle1:STN:280:DC%2BD3svgsFemsg%3D%3D Occurrence Handle12945079

    Article  CAS  PubMed  Google Scholar 

  3. Y Yamamura T Nakajima K Ohta et al. (2002) ArticleTitleDetermining prognostic factors for gastric cancer using the regression tree method Gastric Cancer 5 201–207 Occurrence Handle10.1007/s101200200035 Occurrence Handle12491077

    Article  PubMed  Google Scholar 

  4. Y Maehara H Oiwa S Oda et al. (1995) ArticleTitleSurgical treatment and prognosis for patients with gastric cancer lesions larger than 10 cm in size Oncology 52 35–40 Occurrence Handle1:STN:280:ByqD1MfksFM%3D Occurrence Handle7800340

    CAS  PubMed  Google Scholar 

  5. Y Sakata A Ohtsu N Horikoshi et al. (1998) ArticleTitleLate phase II study of novel oral fluoropyrimidine anticancer drug S-1 (1 M tegafur-0.4 M gimestat-1 M otastat potassium) in advanced gastric cancer patients Eur J Cancer 34 1715–1720 Occurrence Handle10.1016/S0959-8049(98)00211-1 Occurrence Handle1:CAS:528:DyaK1cXntlShurw%3D Occurrence Handle9893658

    Article  CAS  PubMed  Google Scholar 

  6. W Koizumi M Kurihara S Nakano et al. (2000) ArticleTitlePhase II study of S-1, a novel oral derivative of 5-fluorouracil, in advanced gastric cancer Oncology 58 191–197 Occurrence Handle10.1159/000012099 Occurrence Handle1:CAS:528:DC%2BD3cXjvVeitr4%3D Occurrence Handle10765119

    Article  CAS  PubMed  Google Scholar 

  7. H Cho A Tsuburaya O Kobayashi et al. (2003) ArticleTitleLongterm control of advanced and recurrent gastric cancer (ARGC) by S-1 Gastric Cancer 6 IssueIDSuppl 1 24–27 Occurrence Handle12775016

    PubMed  Google Scholar 

  8. W Koizumi S Tanabe K Saigenji et al. (2003) ArticleTitlePhase I/II study of S-1 combined with cisplatin in patients with advanced gastric cancer Br J Cancer 89 2207–2212 Occurrence Handle10.1038/sj.bjc.6601413 Occurrence Handle1:CAS:528:DC%2BD3sXpvVShtbc%3D Occurrence Handle14676796

    Article  CAS  PubMed  Google Scholar 

  9. JD Roder K Boettcher JR Siewert et al. (1998) ArticleTitleClassification of regional lymph node metastasis from gastric carcinoma Cancer 82 621–631 Occurrence Handle10.1002/(SICI)1097-0142(19980215)82:4<621::AID-CNCR2>3.3.CO;2-2 Occurrence Handle1:STN:280:DyaK1c7jsF2muw%3D%3D Occurrence Handle9477092

    Article  CAS  PubMed  Google Scholar 

  10. A Nashimoto H Yabusaki O Tanaka et al. (1999) ArticleTitleNeoadjuvant chemotherapy in advanced gastric cancer with non-curative factors: a phase II study with 5-fluorouracil, leucovorine, and cisplatin Gastric Cancer 2 57–63 Occurrence Handle10.1007/s101200050022 Occurrence Handle11957072

    Article  PubMed  Google Scholar 

  11. InstitutionalAuthorNameJapanese Gastric Cancer Association (1998) ArticleTitleJapanese classification of gastric carcinoma – 2nd English edition Gastric Cancer 1 10–24 Occurrence Handle10.1007/PL00011681 Occurrence Handle11957040

    Article  PubMed  Google Scholar 

  12. LH Sobin CH Wittekind (1997) TNM classification of malignant tumors. International Union Against Cancer EditionNumber5th edn. John Wiley & Sons New York

    Google Scholar 

  13. T Yokota S Ishiyama T Saito et al. (2002) ArticleTitleIs tumor size a prognostic indicator for gastric carcinoma? Anticancer Res 22 3673–3677 Occurrence Handle12552975

    PubMed  Google Scholar 

  14. S Moriguchi Y Maehara D Korenaga et al. (1992) ArticleTitlePrediction of survival time after curative surgery for advanced gastric cancer Eur J Surg Oncol 18 287–292 Occurrence Handle1:STN:280:By2B1Mbht1M%3D Occurrence Handle1607042

    CAS  PubMed  Google Scholar 

  15. Y Adachi T Oshiro M Mori et al. (1997) ArticleTitleTumor size as a simple prognostic indicator for gastric carcinoma Ann Surg Oncol 4 137–140 Occurrence Handle10.1007/BF02303796 Occurrence Handle1:STN:280:ByiB3sbhs1Y%3D Occurrence Handle9084850

    Article  CAS  PubMed  Google Scholar 

  16. T Yoshikawa A Tsuburaya O Kobayashi et al. (2001) ArticleTitleShould scirrhous gastric carcinoma be treated surgically? Clinical experiences with 233 cases and a retrospective analysis of prognosticators Hepatogastroenterology 48 1509–1512 Occurrence Handle1:STN:280:DC%2BD3MrntFalsg%3D%3D Occurrence Handle11677997

    CAS  PubMed  Google Scholar 

  17. JA Ajani RJ Mayer DM Ota et al. (1993) ArticleTitlePreoperative and postoperative combination chemotherapy for potentially resectable gastric carcinoma J Natl Cancer Inst 85 1839–1844 Occurrence Handle1:STN:280:ByuD2cjhtlI%3D Occurrence Handle8230264

    CAS  PubMed  Google Scholar 

  18. A Ohtsu Y Shimada K Shirao et al. (2003) ArticleTitleRandomized phase III trial of fluorouracil alone versus fluorouracil plus cisplatin versus uracil and tegafur plus mitomycin in patients with unresectable, advanced gastric cancer: The Japan Clinical Oncology Group Study (JCOG9205) J Clin Oncol 21 54–59 Occurrence Handle10.1200/JCO.2003.04.130 Occurrence Handle1:CAS:528:DC%2BD2cXpsVWru7k%3D Occurrence Handle12506170

    Article  CAS  PubMed  Google Scholar 

  19. H Katai K Yoshimura K Maruyama et al. (2000) ArticleTitleEvaluation of the new International Union Against Cancer TNM staging for gastric carcinoma Cancer 88 1796–1800 Occurrence Handle10.1002/(SICI)1097-0142(20000415)88:8<1796::AID-CNCR6>3.0.CO;2-2 Occurrence Handle1:STN:280:DC%2BD3c3isFGqsg%3D%3D Occurrence Handle10760754

    Article  CAS  PubMed  Google Scholar 

  20. H Baba T Okuyama H Orita et al. (1992) ArticleTitlePrognostic factors for noncurative gastric cancer: univariate and multivariate analyses J Surg Oncol 51 104–108 Occurrence Handle1:STN:280:ByyD383nsFA%3D Occurrence Handle1405648

    CAS  PubMed  Google Scholar 

  21. H Iwase M Shimada T Tsuzuki et al. (2005) ArticleTitleA phase II multicentric trial of S-1 combined with 24-h infusion of cisplatin in patients with advanced gastric cancer Anticancer Res 25 1297–1302 Occurrence Handle1:CAS:528:DC%2BD2MXkt1Wnurk%3D Occurrence Handle15865081

    CAS  PubMed  Google Scholar 

  22. A Nashimoto T Nakajima H Furukawa et al. (2003) ArticleTitleRandomized trial of adjuvant chemotherapy with mitomycin, fluorouracil, and cytosine arabinoside followed by oral fluorouracil in serosa-negative gastric cancer: Japan Clinical Oncology Group 9206-1 J Clin Oncol 21 2282–2287 Occurrence Handle10.1200/JCO.2003.06.103 Occurrence Handle1:CAS:528:DC%2BD2cXpsVKjsrw%3D Occurrence Handle12805327

    Article  CAS  PubMed  Google Scholar 

  23. K Yasuda N Shiraishi Y Adachi et al. (2001) ArticleTitleRisk factors for complications following resection of large gastric cancer Br J Surg 88 873–8772 Occurrence Handle10.1046/j.0007-1323.2001.01782.x Occurrence Handle1:STN:280:DC%2BD3MzkvFWgtA%3D%3D Occurrence Handle11412261

    Article  CAS  PubMed  Google Scholar 

  24. H Wilke P Preusser U Fink et al. (1989) ArticleTitlePreoperative chemotherapy in locally advanced and nonresectable gastric cancer: a phase II study with etoposide, doxorubicin, and cisplatin J Clin Oncol 7 1318–1326 Occurrence Handle1:STN:280:BiaA287ls1M%3D Occurrence Handle2769330

    CAS  PubMed  Google Scholar 

  25. S Cascinu M Scartozzi R Labianca et al. (2004) ArticleTitleHigh curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer. A report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD) Br J Cancer 90 1521–1525 Occurrence Handle10.1038/sj.bjc.6601752 Occurrence Handle1:CAS:528:DC%2BD2cXjtVWktbk%3D Occurrence Handle15083179

    Article  CAS  PubMed  Google Scholar 

  26. H Yabusaki A Nashimoto O Tanaka (2003) ArticleTitleEvaluation of TS-1 combined with cisplatin for neoadjuvant chemotherapy in patients with advanced gastric cancer (in Japanese) Gan To Kagaku Ryouho 30 1933–1940

    Google Scholar 

  27. I Songun HJ Keizer J Herman et al. (1999) ArticleTitleChemotherapy for operable gastric cancer: results of the Dutch randomized FAMTX trial Eur J Cancer 35 558–562 Occurrence Handle10.1016/S0959-8049(98)00429-8 Occurrence Handle1:CAS:528:DyaK1MXjtVGmsLs%3D Occurrence Handle10492627

    Article  CAS  PubMed  Google Scholar 

  28. T Kinoshita M Konishi T Nakagohri et al. (2003) ArticleTitleNeoadjuvant chemotherapy with S-1 for scirrhous gastric cancer: a pilot study Gastric Cancer 6 IssueIDSuppl 1 40–44 Occurrence Handle12775019

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-ku, Yokohama, 241-0815, Japan

    Osamu Kobayashi, Akira Tsuburaya, Takaki Yoshikawa, Tomohiko Osaragi, Hitoshi Murakami, Tatsuya Yoshida & Motonori Sairenji

Authors
  1. Osamu Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akira Tsuburaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takaki Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomohiko Osaragi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hitoshi Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tatsuya Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Motonori Sairenji
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Osamu Kobayashi.

About this article

Cite this article

Kobayashi, O., Tsuburaya, A., Yoshikawa, T. et al. The efficacy of gastrectomy for large gastric cancer. Int J Clin Oncol 11, 44–50 (2006). https://doi.org/10.1007/s10147-005-0535-4

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-005-0535-4

Key words

Search

Navigation