Prognostic impact of the width of subserosal invasion in gastric cancer invading the subserosal layer

Soga, Koji; Ichikawa, Daisuke; Yasukawa, Satoru; Kubota, Takeshi; Kikuchi, Shojiro; Fujiwara, Hitoshi; Okamoto, Kazuma; Ochiai, Toshiya; Sakakura, Chohei; Kokuba, Yukihito; Yanagisawa, Akio; Otsuji, Eigo

doi:10.1016/j.surg.2009.06.032

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Volume 147, Issue 2 , Pages 197-203, February 2010

Prognostic impact of the width of subserosal invasion in gastric cancer invading the subserosal layer

Koji Soga, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Daisuke Ichikawa, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Reprint requests: Daisuke Ichikawa, MD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 6028566, Japan.
Satoru Yasukawa, MD
- Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Takeshi Kubota, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Shojiro Kikuchi, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Hitoshi Fujiwara, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Kazuma Okamoto, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Toshiya Ochiai, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Chohei Sakakura, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Yukihito Kokuba, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Akio Yanagisawa, MD
- Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Eigo Otsuji, MD
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

Accepted 30 June 2009. published online 16 September 2009.

Background

The depth of wall invasion is one of the most important prognostic factors in patients with gastric cancers. We hypothesized that the horizontal width of spread of the neoplasm in the subserosal layer correlated with frequency of latent tumor exposure to the subserosal surface in subserosal (ss) gastric cancer.

Methods

We compared retrospectively the relationship between the horizontal width of ss invasion and other clinicopathologic factors in 124 patients with ss cancer confirmed carefully to have T2 and not T3 neoplasms. Selected clinicopathologic parameters of these ss patients were compared to 134 patients with serosal penetration (se) by gastric cancer, and 78 patients with invasion of the muscularis propria only (mp).

Results

The width of ss invasion was found to be an important prognostic factor on both univariate (P < .001) and multivariate analyses (P = .006). The prognosis of ss-cancer with narrow-width invasion (less than 20 mm) was similar to that of mp-cancer, while the prognosis of ss-cancer with wide width (more than 20 mm) was similar to that of se-cancer.

Conclusion

Our findings showed that narrow-width ss-cancer (<20 mm) behaved very similar to mp-cancers, while wide ss-cancers (≥20 mm) behaved very similar to se-cancers. These findings demonstrated the prognostic impact of the width of cancer invasion in subserosal layer in patients with ss-cancer. Intensive chemotherapy and close follow-up should be recommended for ss-cancer patients with greater than 20 mm involvement of the subserosal layer.