J.Jpn. Surg. Soc.. 59(2): 263-274, 1958

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HISTOPATHOLOGIC STUDIES ON CARCINOMATOUS DISSEMINATION IN THE OMENTUM IN SURGICAL CASES OF GASTRECTOMY FOR GASTRIC CARCINOMA, WITH SPECIAL REFERENCE TO THE RELATION OF THE DISSEMINATION WITH THE END RESULTS

Of the cases of ordinary gastrectomy for gastric carcinoma in our clinic during the period between April 1941 and March 1956, 643 cases furnished us definite information on the end results of operation. With each of these 643 cases, histologic examination was made of the part of the omentum removed, which was cut into 3 pieces of the lesser omentum and 12 of the great omentum ; and the results were compared with the histopathologic findings on the carcinoma and with the end results in the corresponding case.
(1) Carcinomatous dissemination in the omentum was r ecognized in 500 cases (77.8%) of the 643. In 283 cases of the 500, the dissemination was due to continuous infiltration from the primary cancer focus; in the remaining 217, a focus of carcinomatous dissemination was formed, apart from the primary cancer focus, in the great omentum.
(2) The distribution of carcinomatous dissemination at different parts of the omentum was as follows: 53.0 to 53.7% on the pyloric side of the lesser omentum (highest rate), 38.1 to 41.7% on the pyloric side of the great omentum adjacent to the gastric wall, and 5.8 to 11.0% in the part of the great omentum apart from the gastric wall.
(3) The difference in rate of dissemination according to the position where carcinoma was formed was not significant, thus: The rate was 86.3% for carcinoma at the pylorus, 77.3% at the lesser curvature, and 73.5% at the greater curvature and at the anterior and posterior parts of the gastric wall.
(4) The rate of dissemination showed parallel relationship with the size of carcinoma, thus: The rate was 50.7% for very small tumors (smaller than 9 cm²), 67.8% for small tumors (10 to 19 cm²), 80.4% for medium-sized tumors (20 to 39 cm²), and 88.3% for large tumors (larger than 40 cm²).
As for the r elationship of the dissemination rate with Borrmann's macroscopic types of carcinoma, the rate was 65.9% for type I, 75.0% for type II, 86.2% for type III, and 78.4% for type IV, thus showing no great differences according to the type.
Differences of dissemination rate according to Petersen's histologic types of carcinoma were also small, thus : The rate was 71.9% for carcinoma adenomatosum, 83.2% for carcinoma solidum, and 72.0% for the mixed type. When carcinomas were divided into two-gelationous and non-gelatinous. The rate in the former (90.1%) was much higher than in the latter (63.5%).
(5) There was seen a close relationship between the depth of carcinomatous infiltration of the gastric wall and the dissemination rate, thus : The rate was 28.6% for type Sm, M, in which carcinomatous cells did not go beyond the gastric wall, whereas it was as high as 91.5% for type S, in which carcinomatous cells reached the gastric serosa.
6) The dissemination rate of the group of cases of metastasis in the regional lymph nodes (85.5%) was much higher than that of the non-metastasis group (36.0%). It is to be noted that there was found definite carcinomatous infiltration of the surrounding omentum tissue from the metastatic lymphnodes.
7) In our clinic, carcinomatous peritonitis has been divided into four stages, being based upon the macroscopic findings at the time of operation and corrected by the microscopic findings. With the cases examined in the present investigation, we had a) 143 cases of stage PC. 0 (Peritonitis carcinomatosa 0 degree), in which carcinomatous infiltration was not recognized on the omentum macroscopically and histologically; b) 373 cases of stage PC. I, in which carcinomatous dissemination was restricted to the part of the omentum surrounding the stomach ; and c) 127 cases of stage PC. II, in which the dissemination was more extensive and reached the serosa of the adjacent organs. The end results of these cases were as follows: The 1-year, 2-year, 3-year and 5-year survival rates in the cases of PC. 0 were 97.9, 95.3, 93.3, and 81.3% respectively; those in PC. I were 71.3, 43.7, 31.6, and 24.1% ; and those in PC. II were 40.2, 7.8, 2.9, and 0% (no survivals of ter 4 years). Thus, it will be seen that the survival rate became much lower with increase of the rate of dissemination, the cases of PC. II showing a very unfavorable end results of operation.
(author's abstract)

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