Prognostic factors in patients with diffuse type gastric cancer (linitis plastica) after operative treatment

In a single-center analysis, we investigated 120 patients with diffuse type gastric cancer. All patients underwent a total gastrectomy, 45 patients even a multivisceral resection because of infiltrating growth, or metastases. Serum tumor marker CEA, CA 72-4, and CA 19-9 were recorded in all patients before surgery. An immunocytochemical detection of free peritoneal tumor cells (FPTC) using Ber-EP4 antibody was correlated with tumor stage and survival. Median follow-up time was 38 months.Complete resection rate was 31% (n = 37). 61% (n = 73) of all patients had already distant metastases at the time of surgery, 80% of them peritoneal carcinomatosis. Median survival for the whole group was 8 months, after complete resection 17 months. Lavage cytology, distant metastases, resection rate, and CA19-9 levels had significant influence on survival.A significant survival advantage for patients with diffuse type gastric cancer can only be achived after complete resection. We could define a subset of patients with an extremely poor prognosis even after surgical resection. Meticulous preoperative staging, including a diagnostic laparoscopy to exclude peritoneal carcinomatosis and free peritoneal tumor cells before resection should be mandatory in these patients.Patients with linitis plastica of the stomach, have a poor prognosis with a five year survival of 3-10% in various studies [1,2]. Having this detrimental prognosis in mind, controversy in treatment of these patients still exists. The question is whether surgical resection is suitable for these patients or to begin with a nonoperative treatment [3-6].Since peritoneal seeding, extended lymphnode metastasis and the extension of the tumor into the neighbouring organs are relatively common, only about 20% of the patients with linitis plastica benefit from total gastrectomy [7,8]. Since a complete resection is not possible in the majority of patients with linitis plastica of the stomach, the result of a postoperative radiation