Limited significance of curative surgery in Borrmann type IV gastric cancer

Borrmann type IV advanced gastric cancer has a poor prognosis. Although surgical resection remains the only hope for a cure, the role of curative surgery is questionable in this type of cancer. This study defined the role of curative surgery in the prognosis of type IV gastric cancer. We analyzed 168 patients with Borrmann type IV undergoing surgery at Seoul St. Mary's Hospital from 1989 to 2010. We categorized the patients into curative (R0) and non-curative (R1, R2, and non-resection) groups. The curative and non-curative groups comprised 88 and 80 patients, respectively. The preoperative predictive value of Borrmann type IV was 50.5, and 8.9 % of the patients had microscopic resection margin involvement. The 3-to 5-year overall survival (OS) of patients in the curative group was significantly higher than that of in the non-curative group (p<0.001). However, in a multivariate analysis, curability was not a significant predictor of survival (p = 0.187). In the curative group, the most frequent recurrence site was the peritoneum (85.7 %). Most recurrences occurred within 2 years. The role of surgery for Borrmann type IV is quite limited. Such cases have a poor prognosis even after curative surgery. In addition, microscopic resection margin involvement is frequent in type IV cancer because it is difficult to diagnose preoperatively. Therefore, multimodal diagnostic tools and treatment strategies should be developed for Borrmann type IV gastric cancer.