Back to Annual Meeting Program

Radical surgery with D2 extended lymphadenectomy together with various regimens of peri- or post-operative adjuvant therapy have been shown to be effective for advanced gastric cancer. We aim to evaluate the outcomes of patients who underwent intended curative gastrectomy in our institution and our recurrence rate and pattern.

All patients who underwent radical gastrectomy with curative intent were selected from a prospective gastric cancer database at the National University Hospital, Singapore. Each patient was discussed at a multidisciplinary tumor meeting where decision on adjuvant therapy was made. Patients were followed up at regular intervals. Postoperative complications and recurrence were recorded. Survival and cause of death were confirmed with national registry.

Between year 2000-2010, 645 patients with gastric cancer were treated in our hospital. 274 patients underwent radical surgery with curative intent. The median age was 69 (range: 19-89) and 67% are males. Most tumors were in antrum (53%) or body (28%) and proximal tumors were found in 19% of patients. Subtotal and total gastrectomies were performed in 70% and 30% of patients respectively. R0 resection was achieved in 252 patients (92%). 195(71%) and 79(29%) patients underwent extended lymphadenectomy (D2 or D1+) or limited lymphadenectomy (D1) respectively, according to Japanese Gastric Cancer Treatment Guideline 2010. There were 7(2.5%) peri-operative deaths. Lymph nodes were harvested by pathologists and the median number was 25 for D2/D1+ (range: 15-64) and 18 (range: 3-25) for D1 respectively. Pathological staging (American Joint Committee on Cancer [AJCC] 7th edition) was as follows: I, 24%; II, 22%; III, 43%; IV, 10%. Peri-operative chemotherapy, postoperative chemo-radiotherapy and postoperative chemotherapy were received by 23, 39 and 21 patients respectively. Median follow-up was 25 months. Tumor recurrence occurred in 31% of our patients and the sites of recurrence were: local (29%); lymph nodes (15%); peritoneum (23%); hematogenous (33%). The overall median survival and recurrence free survival are 25 and 21 months respectively. Factors predictive of recurrence pattern will be analyzed and the results will be presented.

Prognosis of gastric cancer remains poor despite earlier detection and improvement in treatment modalities. Recurrence is the most important factor associated with death after curative gastrectomy. Various disease and treatment factors may help to predict the pattern of recurrence and thus provide a tailored treatment guide for our patients.