Gastric linitis plastica: which role for surgical resection?

Abstract

Background The role of surgery for gastric linitis plastica (GLP) is questioned. This study aimed to analyze our experience in the surgical treatment of GLP with specific reference to the resectability rate, prognosis, and mode of recurrence. Methods Results of surgery were analyzed in 102 patients with GLP. Results Of the 102 patients, 92 underwent surgical exploration, with resection performed in 60 cases. R2 resection was carried out in 20 patients and R1 in 12 patients, while the resection was considered potentially curative (R0) in 28 (27.5%). Overall, the median (95% confidence interval [CI]) survival time was 5.7 (3.7-7.5) months, with none of the patients alive at the end date of the study. For R0 patients the median (95% CI) survival time was 15.8 (11-20.7) months. The great majority of recurrences were intra-abdominal (peritoneal and/or locoregional), with a systemic component of the relapse that was rarely observed (5 cases). Conclusions After primary surgery, GLP showed a poor prognosis without regard to the extent or type of resection. The failure of surgical treatment related mainly to the peritoneal spread of the disease. Specifically designed multimodality treatment protocols should be tested in this setting.

Survival following operative management of gastric linitis plastica compared with non-operative management

“…This has been the conclusion of a number of previous studies. 11,12 Diffuse gastric cancer has a rising incidence 2 and is known to have a poorer prognosis than the more common intestinal subtype. 3 Studies looking specifically at survival following surgery for LP have had differing results.…”

“…15 Pedrazzani et al reviewed the outcomes of 102 patients with LP, 92 of whom underwent resection. 12 They used a histological definition of LP and did not use staging laparoscopy or perioperative chemotherapy in their cohort. An overall median survival of 5.7 months (95% CI: 3.7-7.5 months) was demonstrated, which increased to 15.8 months (95% CI: 11-20.7 months) for those who had a R0 resection (27.5%).…”

“…16 Their definition of LP was more in keeping with ours in that the macroscopic appearance was used. However, as with the study by Pedrazzani et al, 12 the patients did not undergo perioperative chemotherapy and staging laparoscopy was not performed as standard. The median survival in patients with a R0 resection was 30.2 months while in those treated with palliative surgery, it was 8.2 months.…”

Multimodal treatment of gastric cancer in the west: Where are we going?

“…Late-phase DT GC can evolve into diffuse infiltration, thickening and stiffening of the gastric wall with reactive fibrosis, also named gastric linitis plastica. This is a subset of GC with a large propensity to diffuse infiltration, massive lymph node metastasis, and peritoneal seeding [31] . The rate of radical resection in this form of GC is < 30%, and, even after R0 resection, the 5-year survival probability does not exceed 5%.…”

Undiagnosed Borrmann type IV gastric cancer despite repeated endoscopic biopsies and PET-CT examination: A case report

“…Borrmann type IV gastric carcinoma is a diffused type of gastric cancer (1) that presents with thickening and stiffening of the gastric wall as a result of invasive infiltration of at least a third of the circumference of the stomach (2). In 1858, Brinton first coined the term linitis plastica, which is also referred to as cirrous carcinoma in English literature, to describe infiltrative gastric carcinoma invading throughout the stomach (3).…”