Abstract
We aimed to determine the frequency and clinical significance of ascites that developed during the follow-up period in patients who underwent curative resection for gastric cancer. The study included 577 patients with gastric cancer who underwent curative gastrectomy. Among them, 184 showed ascites in postoperative follow-up images. Benign ascites was observed in 131 of 490 patients without recurrence, 48 patients (of 87) with recurrence had malignancy-related ascites, and the remaining 5 patients had ascites only prior to recurrence. In most patients without recurrence (97.7%) and in 50% of patients with malignancy-related ascites, the ascites was small in volume and located in the pelvic cavity at the time that it was first identified. However, with the exception of nine patients, malignancy-related pelvic ascites occurred simultaneously or after obvious recurrence. Of those nine patients who had minimal pelvic ascites before obvious recurrence, only one had a clear association with a malignancy-related ascites. In the multivariate analysis, an age of ≤45 was the only independent risk factor for the occurrence of benign ascites. A small volume of pelvic ascites fluid is common in young gastric cancer patients who do not have recurrence after gastrectomy, regardless of sex. It is rare for ascites to be the first manifestation of recurrence.
Highlights
Gastric cancer is one of the leading causes of cancer-related deaths worldwide [1] and most gastric cancer-related deaths are due to recurrence [2]
Diagnosis of peritoneal metastasis is typically determined by a computed tomography [CT] scan
We evaluated the frequency and clinical implications of ascites in patients who underwent curative surgery for gastric cancer
Summary
Gastric cancer is one of the leading causes of cancer-related deaths worldwide [1] and most gastric cancer-related deaths are due to recurrence [2]. There is little convincing evidence that intense surveillance improves survival, routine follow-up after curative resection for the early detection of recurrence in gastric cancer is considered general practice, as some research findings indicate that asymptomatic patients had longer post-recurrence and overall survival than symptomatic patients [10,11,12]. Physicians often encounter ascites in abdominal imaging during the post-gastrectomy follow-up period and there are concerns that this finding may indicate early peritoneal recurrence, especially in men, despite a lack of evidence otherwise. Detected ascites in CT strongly suggests the presence of peritoneal metastasis and free cancer cells in patients with advanced gastric cancer [13,14]. The clinical significance of ascites detected by postoperative CT or other abdominal imaging during the follow-up period is not well-studied. We evaluated the frequency and clinical implications of ascites in patients who underwent curative surgery for gastric cancer
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