The pathologic characteristics of gastric cancer in 57 patients with hematogenous recurrence were pathologically analyzed by the site of recurrence. In recurrence of gastric cancer that developed in the liver, macroscopic observation revealed that cancers of Borrmann type 2 and 3 were most frequent. Microscopic examination revealed that the rate of occurrence of the medullary type of differentiated or poorly differentiated adenocarcinoma were high and that there were relatively frequent invasion by cancerous cells of the blood vessel that were closely related to the hematogenous metastasis. On the other hand, with respect to recurrence of gastric cancer that had developed in the lung or bone, Borrmann type 3 and 4, respectively, were more frequently observed. In these cases, microscopic analysis revealed that these cancers were poorly differentiated adenocarcinomas. In gastric cancer with bone recurrence, the rate of recurrence of the scirrhous type of tumor were higher than that of other types. It is important, for the management of patients after gastric cancer surgery, to predict possible hematogenous recurrence and its site by evaluation of the pathologic characteristics of the gastric cancer.
We examined the relationship between the spatial extent of invasion of the gastric serosa in patients with gastric carcinoma and their postoperative 5-year survival rate. At the time of surgical resection of gastric cancer, intraperitoneal free cancer cells were detected by lavage of the Douglas cavity in 135 of 309 (44%) patients with gross evidence of serosal invasion. Examination of the relationship between the presence of intraperitoneal free cancer cells and serosal area invaded by the tumor revealed that only 22% of cases with an area of serosal invasion 10 cm2 or less were positive for free cancer cells, but such cells were found in 72% of cases with an area of serosal invasion greater than 20 cm2. The 5-year survival rate was 31% in patients with an area of serosal invasion of less than 10 cm2, whereas the rate was only 8% in patients with an area of serosal invasion greater than 20 cm2. Not only the presence of serosal invasion by a tumor but also the spatial extent of the invasion are significant factors that influence the prognosis of patients with gastric carcinoma.
To assess the efficacy of proximal gastrectomy in the treatment of upper gastric carcinoma, we analyzed clinical data from patients with lesions confined to the upper third of the stomach (group 1) and from patients with lesions which, while primarily located in the upper portion of the stomach, showed spread to the body of the stomach (group 2). Patients in group 2 showed more metastatic lymph node involvement, particularly of the infrapyloric lymph nodes, which were not included in lymphadenectomy accompanying proximal gastrectomy. None of the group 1 patients demonstrated metastasis to the infrapyloric lymph nodes. The postoperative 5-year survival rate in curatively operated group 1 patients was not significantly different between those treated by proximal gastrectomy and those subjected to total gastrectomy. We conclude that proximal gastrectomy is indicated in patients with upper gastric carcinoma when it is confined to the upper third of the stomach.
We studied the histology of resected specimens from 71 gastric cancer patients with synchronous and metachronous liver metastasis to assess the predominance of a particular histological pattern in gastric cancer with a tendency for liver metastasis. Poorly differentiated adenocarcinoma manifesting a medullary growth pattern was the most frequent histologic pattern (33%), followed by papillary adenocarcinoma (28%) in 39 patients with synchronous liver metastasis. In 32 patients who developed metachronous liver metastasis as the main pattern of recurrence, papillary adenocarcinoma was most frequent (47%), followed by poorly differentiated adenocarcinoma of the medullary type (28%). Scirrhous carcinoma was not encountered in patients manifesting metachronous liver metastasis. As most of the papillary adenocarcinomas exhibited a medullary growth pattern, we hypothesize that gastric cancer of the medullary type tends to metastasize to the liver, irrespective of the basic histologic pattern, and that poorly differentiated adenocarcinoma of the medullary type has a particularly high tendency for metastasizing to the liver.
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