Annals of Surgical Oncology

, Volume 16, Issue 1, pp 42–50 | Cite as

Attempted Salvage Resection for Recurrent Gastric or Gastroesophageal Cancer

  • Brian Badgwell
  • Janice N. Cormier
  • Yan Xing
  • James Yao
  • Debashish Bose
  • Sunil Krishnan
  • Peter Pisters
  • Barry Feig
  • Paul Mansfield
Gastrointestinal Oncology


The purpose of this study was to determine the outcome of surgery for patients with recurrent gastric or gastroesophageal cancer. We queried records from 7,459 patients who presented with gastric or gastroesophageal cancer to our institution from 1973 through 2005 to identify those for whom resection of recurrent disease had been attempted. We assessed the associations between various clinicopathologic factors and resectability with logistic regression analysis and between clinicopathologic factors and overall survival (OS) with the Cox proportional hazards model. Sixty patients underwent attempted resection for recurrent cancer. In 31 cases (52%), recurrent disease proved unresectable at laparotomy. Factors associated with the ability to undergo re-resection included neoadjuvant treatment prior to initial resection [odds ratio (OR) 12.2, 95% confidence interval (CI) 1.9–75.6] and having an isolated local recurrence (OR 5.1, 95% CI 1.3–20.5). Of the 29 patients who underwent re-resection, 14 required adjacent organ resection, and 6 required interposition grafting. Three- and 5-year OS rates for all 60 patients were 21% and 12%, respectively; median follow-up time was 23 months. Median OS for patients undergoing resection was 25.8 months (95% CI 17.1–49.8) versus 6.0 months (95% CI 4.0–10.5) for unresectable patients (P < 0.001). Initial tumor location at the gastroesophageal junction was associated with diminished OS [hazard ratio (HR) 2.8, 95% CI 1.2–6.5] and ability to undergo resection of recurrence was associated with improved OS (HR 0.2, 95% CI 0.1–0.6). We conclude that surgical resection of select patients with recurrent gastric or gastroesophageal cancer can result in improved OS but often requires adjacent organ resection or interposition graft placement.


Overall Survival Unresectable Disease Primary Tumor Resection Initial Resection Linitis Plastica 
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  1. 1.
    Maehara Y, Hasuda S, Koga T, et al. Postoperative outcome and sites of recurrence in patients following curative resection of gastric cancer. Br J Surg. 2000;87:353–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Schwarz RE, Zagala-Nevarez K. Recurrence patterns after radical gastrectomy for gastric cancer: prognostic factors and implications for postoperative adjuvant therapy. Ann Surg Oncol. 2002;9:394–400.CrossRefPubMedGoogle Scholar
  3. 3.
    D’Angelica M, Gonen M, Brennan MF, et al. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg. 2004;240:808–16.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Yoo CH, Noh SH, Shin DW, et al. Recurrence following curative resection for gastric carcinoma. Br J Surg. 2000;87:236–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Kodera Y, Ito S, Yamamura Y, et al. Follow-up surveillance for recurrence after curative gastric cancer surgery lacks survival benefit. Ann Surg Oncol. 2003;10:898–902.CrossRefPubMedGoogle Scholar
  6. 6.
    Carboni F, Lepiane P, Santoro R, et al. Treatment for isolated locoregional recurrence of gastric adenocarcinoma: does surgery play a role? World J Gastroenterol. 2005;11:7014–7.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Miller RC, Haddock MG, Gunderson LL, et al. Intraoperative radiotherapy for treatment of locally advanced and recurrent esophageal and gastric adenocarcinomas. Dis Esophagus. 2006;19:487–95.CrossRefPubMedGoogle Scholar
  8. 8.
    Bohner H, Zimmer T, Hopfenmuller W, et al. Detection and prognosis of recurrent gastric cancer –is routine follow-up after gastrectomy worthwhile? Hepatogastroenterology. 2000;47:1489–94.PubMedGoogle Scholar
  9. 9.
    Takeyoshi I, Ohwada S, Ogawa T, et al. The resection of nonhepatic intraabdominal recurrence of gastric cancer. Hepatogastroenterology. 2000;47:1479–81.PubMedGoogle Scholar
  10. 10.
    Inada T, Ogata Y, Andoh J, et al. Significance of paraaortic lymph node dissection in patients with advanced and recurrent gastric cancer. Anticancer Res. 1994;14:677–82.PubMedGoogle Scholar
  11. 11.
    Shchepotin I, Evans SR, Shabahang M, et al. Radical treatment of locally recurrent gastric cancer. Am Surg. 1995;61:371–6.PubMedGoogle Scholar
  12. 12.
    Huguier M, Houry S, Lacaine F. Is the follow-up of patients operated on for gastric carcinoma of benefit to the patient? Hepatogastroenterology. 1992;39:14–6.PubMedGoogle Scholar
  13. 13.
    Makela J, Kairaluoma MI. Rationale of reoperation for gastric malignancies. Ann Chir Gynaecol. 1985;74:77–81.PubMedGoogle Scholar
  14. 14.
    Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. New York: Spring-Verlag; 2002.CrossRefGoogle Scholar
  15. 15.
    Snedecor G, Cochran, WG. Statistical methods. Ames: Iowa State University Press; 1980.Google Scholar
  16. 16.
    Kaplan E, Meier, P. Nonparametric estimator from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRefGoogle Scholar
  17. 17.
    Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;60:163–70.Google Scholar
  18. 18.
    Adachi Y, Kitano S, Sugimachi K. Surgery for gastric cancer: 10-year experience worldwide. Gastric Cancer. 2001;4:166–74.CrossRefPubMedGoogle Scholar
  19. 19.
    Davis PA, Sano T. The difference in gastric cancer between Japan, USA, and Europe: what are the facts? what are the suggestions? Crit Rev Oncol Hematol. 2001;40:77–94.CrossRefPubMedGoogle Scholar
  20. 20.
    Ohtsu A, Yoshida S, Saijo N. Disparities in gastric cancer chemotherapy between the East and West. J Clin Oncol. 2006;24:2188–96.CrossRefPubMedGoogle Scholar
  21. 21.
    An JY, Youn HG, Ha TK, et al. Clinical significance of tumor location in remnant gastric cancers developed after partial gastrectomy for primary gastric cancer. J Gastrointest Surg. 2008;12(4):689–94.CrossRefPubMedGoogle Scholar
  22. 22.
    Ohashi M, Katai H, Fukagawa T, et al. Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg. 2007;94:92–5.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Brian Badgwell
    • 1
  • Janice N. Cormier
    • 2
  • Yan Xing
    • 2
  • James Yao
    • 3
  • Debashish Bose
    • 2
  • Sunil Krishnan
    • 4
  • Peter Pisters
    • 2
  • Barry Feig
    • 2
  • Paul Mansfield
    • 2
  1. 1.Department of Surgical OncologyWinthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Department of Surgical Oncology, Unit 444The University of Texas M. D. Anderson Cancer CenterHoustonUSA
  3. 3.Department of Gastrointestinal Medical OncologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA
  4. 4.Department of Radiation OncologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA

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