Clinicopathological Characteristics and Surgical Treatment Analysis for Gastric Carcinoma in Stage III

OBJECTIVE To study the clinicopathological and surgical treatment of gastric carcinoma in stage III.

METHODS A total of 484 cases of gastric carcinoma were treated with different methods and their efficacy evaluated. These included 114 and 102 cases with D2 and D3 lymphadenectomy, respectively, 48 with intraoperative radiation therapy (IORT) and 18 with peritoneal infusing chemotherapy combined with TIL.

RESULTS The total rate of lymph nodes metastasis (LNM) was 79.5% (384/ 484) and the degree of LNM 41.2% (4169/10121). The incidence of LNM of N1, N2, N3 and N4 was 68.8%, 34.6%, 19.6% and 3.5%, respectively. The rate of serosa linking to peripheral tissues or organs was 23.15% (112/484) including 12.5% cancerous linkage. The survival rates for patients treated with D3 lymphadenectomy at 1-, 3-5-8- and 10-years were significantly higher than that for D2 lymphadenectomy. The 5-year survival rate with application of IORT increased remarkably compared to the operation-alone group. Peritoneal lavage with 2000 ml of 43°C distilled water before closure of the abdominal incision and postoperative peritoneal infusing chemotherapy with TIL significantly decreased the rate of peritoneal metastasis.

CONCLUSION Due to the specificity of gastric carcinoma in stage III, the surgical principles are to perform an extensive radical operation, in combination with IORT plus different peritoneal infusing therapy to improve the long term survival rate.