Treatment for isolated loco-regional recurrence of gastric adenocarcinoma: Does surgery play a role?

AIM： To evaluate the role of surgical treatment for isolated Ioco-regional recurrences of operated gastric adenocarcinoma. METHODS： Among the 837 patients operated for gastric adenocarcinoma between December 1979 and April 2004, 713 （85%） underwent resection with curative intent. A retrospective review of a prospectively collected gastric cancer database was carried out. Overall recurrence rate was 44% （315 cases）, with 75% occurring within the first 2 years from the operation. Isolated L-R recurrences were observed in 38 （12%） patients. Symptomatic lesions were observed in 27 （71%）. RESULTS： Six （16%） patients were macroscopically resected with curative intent. The recurrence was located in the gastric stump after a STG in three patients, in the esophagojejunal anastomosis after a TG in two patients and in the gastric bed after a TG in one patient. Surgical procedures consisted of three secondary TG, two esophagojejunal resection and one excision of an extraluminal recurrence. Postoperative complications occurred in two patients （33%）, including one anastomotic leakage and one hemorrhage. The latter patient died of sepsis 35 d after the surgery （mortality rate 17%）. All patients died of recurrent gastric cancer： 2 within 1 year from surgery （8 and 11 mo, respectively）, 2 after 16 and 17 mo respectively and 1 after 28 mo from the second operation. CONCLUSION： Surgery plays a very limited role in the treatment for isolated Ioco-regional recurrence of gastric adenocarcinoma.