術後5年以後に再発した胃癌症例の検討―外科臨床の立場から

Evaluation of Recurrence Cases of Gastric Cancer over Five Years after Operation: From the standpoint of clinical surgery

　近時胃癌術後の長期生存例の増加とともに，従来，それほど問題にされていなかった術後5年以上経過後の後期再発に対する関心も高まってきている．

　進行胃癌がなお大半を占め，術後の再発も少なくない現状では，原発胃癌に対してだけでなく，再発胃癌に対しても，積極的な早期診断ならびに治療が必要である．

　The subjects of this report are 17 recurrence cases over five years postoperatively in 864 patients operated on for gastric cancer, who were followed up five or more years from 1948 to 1970 in the author's department.

　The macroscopical and histological findings of the resected stomach in late recurrence cases were compared with special reference to the recurrence time and recurrence pattern in 105 cases, of which early (less than 2 years) recurrence cases were 84, intermediate (2～4 years) 21. The following results were obtaind.

　1. The rate of late recurrence was 2.0 per cent or 17 out of 864 cases resected for the primary gastric cancer, and the mortality rate in late recurrence was 5.8 per cent, or 21 out of 360 fatal recurrence cases.

　2. The male outnumbered the female with a ratio of 2.2: 1.0, and the highest incidence was seen in their twenties with a frequency of 17 per cent.

　3. The duration of the disease before the first gastrectomy was comparatively long in many of late recurrence cases. This fact indicated slow development of gastric cancer in these cases.

　4. Late recurrence cases showed many of Borrmann's type 2 and the circumscribed type (Kajitani's classification), ps(-) cancer (m～(ssγ) cancer). pm cancer were especially many as were differentiated adenocarcinoma such as papillaly, well differentiated tubular and moderately differentiated tubular adenocarcinoma, and stage Ⅰ and Ⅱ.

　5. The main types in late recurrence cases were as follows: metastasis to the liver was 6 cases, peritoneal dissemination 5, recurrence in the gastric stump 4, local recurrence in the lower part of the liver and lung metastasis were each 1. Most of the cases showed hematogenous metastasis.

　6. In late recurrence, liver metastasis was mostly recognized in the circumscribed type, Borrmann's type 2, ps(-) cancer, especially pm cancer, differentiated adenocarcinoma and INFβ. On the other hand, peritoneal dissemination was seen in Borrmann's type 3, ps(+) cancer (ssγ～sei cancer), infiltrating type, poorly differentiated adenocarcinoma and INFγ. A few cases of the poorly differentiated type of ps(-) led to peritoneal recurrence in late stage.