Local recurrence of gastric cancer after surgery mainly refers to recurrent tumors around the anastomosis after gastrectomy, which mostly manifests as symptoms of anastomotic stricture such as abdominal distention and vomiting, yellowing of the skin and sclera (jaundice), and abdominal masses. As the local recurrent tumor progresses, extensive lymph node metastasis may occur, and the lymph nodes corresponding to the infiltrated organs also appear.
For locally recurrent gastric cancer, the physician will choose an appropriate treatment plan based on a combination of factors, including the patient’s general condition, the early stage of the disease, the form and location of recurrence, the time of recurrence, and the degree of radicalization from the first surgery.
Surgical treatment
A comprehensive treatment model based on surgical resection is the most effective way to treat locally recurrent gastric cancer. Surgical options include radical resection, palliative resection, subtotal surgery (which acts to relieve symptoms), and exploratory biopsy. In general, the specific surgical approach will vary for patients at different stages of disease, as follows:
- For patients who still have a chance of radical resection, the best treatment modality remains a comprehensive treatment model based on radical resection;
- For patients who have lost the opportunity for radical resection with complications, physicians may consider palliative partial resection and short-circuiting of the lesion and/or metastases (i.e., bypassing the lesion causing the obstruction to connect the stomach to the intestine so that food is rerouted from the stomach directly to the intestine) to improve quality of life and possibly even create conditions for subsequent treatment;
- For patients with undiagnosed but prognostic limited lesions and high suspicion of recurrence, physicians will consider exploratory biopsy, which is positive for patients overall because local area recurrence is seen in 54.3% of overall recurrence patients, 25.9% of which are not associated with peritoneal implants and distant metastases;
- For patients who cannot tolerate surgery or for patients with extensive local infiltration combined with bleeding, obstruction, and other comorbidities, physicians usually perform only subtractive surgery or palliative resection.
Adjuvant chemotherapy
For patients with local recurrence of gastric cancer after surgery, chemotherapy is also the primary treatment. When choosing a chemotherapy regimen, physicians primarily refer to the treatment of progressive gastric cancer, with a less toxic two-drug regimen usually preferred for first-line treatment, mostly fluorouracil or capecitabine in combination with cisplatin or oxaliplatin. For patients with HER2-positive gastric adenocarcinoma, known as human epidermal growth factor receptor 2, doctors usually combine trastuzumab (Trastuzumab, trade name Herceptin) with first-line chemotherapy.
It is now generally accepted that in patients who have received standard adjuvant chemotherapy after radical surgery, if recurrence occurs more than 1 year after the end of adjuvant chemotherapy, the original adjuvant chemotherapy regimen may still be an option; otherwise, the original chemotherapy regimen may be considered ineffective and physicians may readjust the dosing regimen.
Summary
For patients with local recurrence of gastric cancer after surgery, a combination of multiple treatment modalities such as surgery and chemotherapy remains the main treatment for now.
- Radical resection provides a significant survival benefit and improves quality of life.
- Palliative surgery alone does not provide a survival benefit, but for those with complications, it not only improves quality of life to some extent, but also provides an opportunity for chemotherapy.
- As new drugs continue to be developed and clinical studies continue, even patients who are unable to undergo surgery may benefit from an integrated treatment model of chemotherapy with multiple other therapies. (Contributed by Wenbin Hou, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)