Late development of a second primary carcinoma of the stomach

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MULTICENTRIC cancer of the stomach has been long recognized1 and is not rare. The development of a second primary cancer many years after the original gastric resection has received less attention in the literature and presumably occurs only rarely. As the number of long-term survivors of successfully treated cancer of the stomach increases, one may expect an increase in the number in whom a second cancer develops. Such patients will never be numerically great, but their existence at all will alert the physician to such a possibility, and lead to prompt surgical exploration and a possible second ‘cure.’

Our study is based upon a small group of patients who seemed to qualify according to four criteria designed to minimize the possibility that the supposed second primary growth was actually a recurrence of the original carcinoma (Table 1). These criteria are:

(1) The original gastric resection must seem to be curative; i.e., there was no evidence of preoperative or postoperative metastatic spread beyond the limits of the resection; all visible or palpable tumor was removed; and the pathologist found the lines of resection free of tumor.

(2) Sufficient time must have elapsed from the original gastric resection. There is no absolute number of years postoperatively in which to exclude recurrence of any cancer. For cancer of the stomach, most patients destined to die of the disease will succumb within three years, but recurrences as late as 16 years after gastrectomy have been observed by one of us (S.O.H.). Five years without . . .



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