[Regularities of relapse and metastasis of signet ring cell carcinoma of the stomach following combined and surgical treatment].

Characteristics of recurrence and metastatic development of signet ring cell carcinoma of the stomach were studied in 59 cases after combined and surgical treatment. Peritoneal dissemination appeared to be the most frequent pattern of tumor progression. It accounted for 55% of all relapses and occurred in 27% of patients even without extension through serous membrane (pT2). Metastasizing through the lymphatic viae was fairly frequent mostly in cases of peritoneal carcinomatosis while blood flow-related dissemination was not. Subtotal resection in patients with early-stage signet ring cell carcinoma (pT1) was justified because local recurrences are extremely rare in that pathology. Since (pT2-4) stump relapse is fairly frequent (14-16%), the operation of choice was gastrectomy, whatever site of tumor. Regional metastasis recurrence was 20% among patients with relapsing tumor. It usually co-occurred with distant metastases and, therefore, was less clinically significant. However, when concomitant with local recurrence, it ruled out radical treatment. Preoperative radiotherapy was followed by a significant drop in regional metastasis recurrence rate (4.5 and 13.3%, p = 0.04).