Clinicopathological Characteristics of Remnant Gastric Cancer After a Distal Gastrectomy

Introduction

The survival rate of patients with remnant gastric cancer (RGC) is unfavorable in comparison to that of cancer in the nonresected stomach. However, when RGC is curatively resected, no significant differences have been reported between both groups in regard to survival. The aim of this study is to analyze the clinicopathological factors influencing a curative resection of RGC.

Methods

Thirty-eight consecutive patients with RGC from January 1, 1994 through March 31, 2009 were enrolled in this retrospective study.

Results

Their primary diseases were gastric cancers (21; 55.3%) and benign diseases (17; 44.7%). The type of the reconstruction methods of first gastrectomy were Billroth I (28; 73.7%) and Billroth II (10; 26.3%). A total of 31 patients underwent a laparotomy. Twenty patients underwent a curative resection, four patients underwent a palliative resection, and seven underwent a nonresective operation. A total of seven patients underwent an endoscopic resection for early gastric cancer, and all patients received a curative resection. Univariate and multivariate logistic regression analyses were performed to identify the clinicopathological and background factors influencing a curative resection of RGC. A multivariate analysis revealed only an annual follow-up endoscopic examination after the initial gastrectomy to be an independent factor for a curative resection (p?=?0.016; odds ratio, 35.3).

Conclusions

An annual follow-up endoscopic examination an after initial gastrectomy may be related to improving the prognosis of patients with RGC.     

Is There a Role for Palliative Gastrectomy in Patients with Stage IV Gastric Cancer?

Patients with metastatic gastric cancer are currently not considered operative candidates and are most often offered systemic therapy. Palliative resection of the primary tumor has been considered irrelevant to the outcome and has been recommended only for palliation of symptoms. We have examined the role of palliative gastrectomy and its impact on survival in patients with stage IV gastric cancer at initial diagnosis between 1990 and 2000. A total of 105 patients with stage IV disease were identified during this period; 81 of them (77.1%) had no resection, and 24 (22.9%) underwent palliative gastric resection. Mean survival in those without resection who received chemotherapy (with or without radiation) treatment was 5.9 months (95% confidence interval 4.2–7.6). For those with resection and adjuvant therapy, mean survival time was 16.3 months (95% confidence interval 4.3–28.8 months). Kaplan-Meier survival analysis showed significantly better survival in those with resection and adjuvant therapy (log-rank test, P = 0.01). Mortality and morbidity rates associated with palliative resection were 8.7% and 33.3%, respectively, which did not differ statistically from the 3.7% and 25.3% in patients who underwent curative gastrectomy during same period of time. However, the length of hospitalization (22 versus 16 days) was significantly higher compared with those without stage IV disease. These data suggest that palliative resection combined with adjuvant therapy may improve survival in a selected group of patients with stage IV gastric cancer. Palliative gastrectomy plus systemic therapy should be compared with systemic therapy alone in a randomized trial.     

残胃癌的临床病理特征

目的 探讨残胃癌的临床病理特征及其治疗方法.方法 回顾性分析9年间收治的25例良性病变行胃次全切除术后发生残胃癌手术患者的病理和临床资料.结果 残胃癌男女比例约为5:1,发生于首次手术后12～35年,平均24.5年,首次手术为Billroth Ⅱ式者占80.0%.患者就诊时为进展期,淋巴结转移以残胃大弯侧、空肠系膜为主.均行手术治疗,行根治性手术切除14例(56.0%),姑息性切除11例(44.0%).术后辅以辅助化疗18例.随访3～12年,1,3,5年总体生存率分别为72.0%,56.0%,36.0%.根治性手术后为78.5%,71.4%,50.0%;姑息性手术后为63.6%,36.3%,18.1%(P＜0.05).手术联合化疗组的5年生存率为44.4%(8/18),显著高于单纯手术治疗组的14.3%(1/7)(P＜0.05).结论 残胃癌以手术联合辅助化疗的治疗方案仍能获得较好的临床效果.     

Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study

Background

The benefits and feasibility of laparoscopic surgery for remnant gastric cancer are still unclear. The purpose of this study was to describe the detailed procedure and to evaluate the clinical short-term outcomes of laparoscopic total gastrectomy (LTG) compared with open total gastrectomy (OTG) for remnant gastric cancer (RGC).

Methods

Of 1,247 consecutive patients who underwent gastrectomy for gastric cancer in our department at Kyushu University Hospital from January 1996 to May 2012, 22 patients who underwent successful curative resection of RGC with precise nodal dissection were enrolled in this study. Twelve patients underwent LTG and the remaining ten patients underwent OTG. We analyzed the clinical short-term outcomes of LTG and compared the results between LTG and OTG groups to evaluate the safety and feasibility of LTG.

Results

Twelve patients with RGC successfully underwent LTG without open conversion and morbidity. The mean operation time of LTG, 362.3 ± 68.4 min, was significantly longer than that of OTG (p = 0.0176), but the mean blood loss of LTG, 65.8 ± 62 g, was smaller than that of OTG (p < 0.01). The mean postoperative times to resumption of water and food intake were significantly shorter in the LTG group than in the OTG group (p < 0.01). The overall 3-year survival rate was comparable between the LTG and OTG groups (77.8 vs. 100 %; p = 0.9406).

Conclusions

This study shows that LTG is a feasible and reliable procedure for the treatment of RGC in terms of short-term outcomes.     

Remnant gastric cancer: An ordinary primary adenocarcinoma or a tumor with its own pattern?

BACKGROUNDRemnant gastric cancer (RGC) is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis. However, there little information available regarding RGCs and their prognostic factors and survival.AIMTo evaluate the clinicopathological characteristics and prognosis of RGC after previous gastrectomy for benign disease.METHODSPatients who underwent curative resection for primary gastric cancer (GC) at our institute between 2009 and 2019 were retrospectively evaluated. All RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in this study. Primary proximal GC (PGC) who underwent total gastrectomy was selected as the comparison group. Clinical and pathological data were collected from a prospective medical database.RESULTSA total of 41 patients with RGC and 120 PGC were included. Older age (P = 0.001), lower body mass index (P = 0.006), hemoglobin level (P < 0.001), and number of resected lymph nodes resected (LN) (P < 0.001) were associated with the RGC group. Lauren type, pathological tumor-node-metastasis, and perioperative morbimortality were similar between RGC and PGC. There was no difference in disease-free survival (P = 0.592) and overall survival (P = 0.930) between groups. LN status was the only independent factor related to survival. CONCLUSIONRGC had similar clinicopathological characteristics to PGC. Despite the lower number of resected LN, RGC had a similar prognosis.     

Differences of the Lymphatic Distribution and Surgical Outcomes Between Remnant Gastric Cancers and Primary Proximal Gastric Cancers

Background

Although remnant gastric cancer (RGC) following distal gastrectomy is located in the proximal stomach, little is known about the differences of the lymphatic distribution and surgical outcomes between RGC and primary proximal gastric cancer (PGC).

Methods

Between 1997 and 2008, 1,149 patients underwent gastrectomy for gastric cancer. Of these, 33 (2.9%) RGC patients and 207 (18.5%) PGC patients were treated at our department. We reviewed their hospital records retrospectively.

Results

Compared with the PGC patients, those with RGC had a slightly higher age at onset (p?=?0.09), higher incidence of undifferentiated cancer (p?=?0.06), higher incidence of vascular invasion (p?=?0.09), and higher incidence of T4 (p?=?0.07). Gastrectomy for RGC involved greater blood loss (p?p?=?0.01), combined resection, and high incidence of complications. However, the survival rate for RGC patients was similar to that for PGC patients (p?=?0.67). 2) Patients with RGC had a different pattern of lymph node metastasis compared with that in PGC. Particularly in advanced RGC with pT2?CT4 tumors, RGC frequently demonstrated jejunal mesentery lymph node metastases (RGC vs. PGC, 35% vs. 0%) and splenic hilar lymph node metastases (RGC vs. PGC, 17% vs. 10%). The jejunal mesentery lymph node metastases were detected only following Billroth II reconstruction (Billroth I vs. Billroth II, 0% vs. 67%).

Conclusion

Although the clinical behaviors of the two gastric cancers were different, the survival rates were similar. The pattern of metastasis indicates that the jejunal mesentery and splenic hilar lymph nodes should be specifically targeted for en bloc resection during complete gastrectomy in RGC.     

Surgery: Independent Prognostic Factor in Curable and Far Advanced Gastric Cancer

The hospital records of 639 patients affected by primary gastric cancer who were consecutively admitted to our unit during the period 1981–1995 were reviewed. Overall 220 underwent total gastrectomy (38 palliative), 12 had resection of the gastric stump, 195 had distal subtotal gastrectomy (55 palliative), 78 had bypass procedures, 72 had explorative laparotomy, and 62 had no operation. Univariate and multivariate analyses were used to evaluate 5-year survival with respect to the main clinical, pathologic, and treatment variables after both curative and palliative treatments. Overall the 5-year survival after curative treatment (320 patients—operative mortality excluded) was 55.5%: 91.1% for stage IA, 71.5% IB, 62.4% II, 37.5% IIIA, 31.5% IIIB. Among patients who underwent palliative treatment 5-year survival was 13.1% after gastric resection (total or distal subtotal), 4.9% after the bypass procedures, 0 after explorative laparotomy, and 0 after no operation. Univariate and multivariate survival analyses showed that variables independently associated with poor survival were advanced stage, upper location and D1 lymphadenectomy after curative treatment, tumor spread to distant sites, and nonresectional surgery after palliative treatment. Multivariate analysis showed that even though survival with gastric cancer depends on predetermined factors, the type of surgery can have a significant effect on prognosis after both curative and palliative treatment.     

The radical treatment of gastric carcinoma

AIM: The aim of this paper is to review and assess the selective principles for a radical treatment of gastric carcinoma with respect to resection type as well as the role of lymphadenectomy. METHODS: From 1994 to 1999, we operated 222 patients affected by gastric adenocarcinoma at the 1st Surgical Clinic Institute in Padua. Out of the whole group, 138 patients (62.1%) underwent radical surgical treatment (75 patients with total gastrectomy, extended in 30 cases, and 63 patients by means of gastric resection). RESULTS: The overall survival rate at a median follow-up of 4 years was 58% for the patients treated with total gastrectomy, and 77% in case of distal gastric resection; 97% of patients with early gastric cancer are alive at a median follow-up of 3 years. CONCLUSION: Whenever it is feasible, subtotal gastrectomy could ensure a radical treatment of gastric carcinoma with low morbidity and mortality rate. The survival rate of such patients was 77%. Prognosis of early gastric cancer is excellent. Patients with IV stage tumors surgically treated had a poor outcome, and they should be susceptible of a multidisciplinary palliative approach.     

The outcome of patients with remnant primary gastric cancer compared with those having upper one-third gastric cancer

BACKGROUND: Although the prognosis for patients with remnant gastric cancer has been considered to be poor, few reports exist concerning outcomes of these patients. The objective of this study was to evaluate clinicopathologic features and prognostic outcomes of patients with remnant primary gastric cancer compared with the same findings for patients with upper-one third cancer of the stomach. METHODS: Thirty-eight patients with remnant primary gastric cancer and 794 patients with primary upper one-third cancer who underwent surgery at Samsung Medical Center between 1995 and 2004 were enrolled in this study. Clinicopathologic characteristics, tumor stages, and survival times were analyzed. RESULTS: The mean interval between previous gastrectomy and diagnosis of remnant primary gastric cancer was 18.8 years for patients who had undergone their first gastrectomy for malignant disease (n = 13) and 28.6 years for patients with benign disease (n = 25). Patients with remnant primary gastric cancer showed a greater male predominance compared with patients having upper one-third cancer (92.1% vs 65.5%, respectively, P = .001). Patient distribution according to operative curability, tumor size, stage, and histology showed no significant differences between the 2 groups. Overall 5-year survival rates of patients with remnant primary gastric cancer and those with upper one-third cancer were 53.7% and 62.9% (P = .346), respectively. Differences in the 5-year survival rates at each stage between the groups were not statistically significant. CONCLUSIONS: Operative curability, tumor stages, and prognoses of patients with remnant primary gastric cancer are similar to those having upper one-third cancer. Early diagnosis and an aggressive surgical approach may be important to achieve better outcomes for patients with remnant primary gastric cancer.     

胃切除方式对胃中部癌患者预后的影响

目的探讨胃切除方式对胃中部癌患者预后的影响。方法回顾性分析1998年1月至2005年12月间福建医科大学附属协和医院收治的222例胃中部癌患者的临床资料,其中行开腹远端胃大部切除术66例（DG组）,行开腹全胃切除术患者156例（TG组）,比较两组患者术后5年的生存率。结果DG组和TG组术后5年生存率分别为63．9％和49．8％,差异具有统计学意义（P〈0．05）。但相比之下,TG组患者肿瘤更大、分期更晚、肿瘤位于小弯侧者居多（均P〈0．01）。按TNM分期进行分层预后分析显示,相同病期的两组患者术后5年生存率的差异均无统计学意义（均P〉0．05）。无论是以4cm、5cm还是6cm作为近切缘截点,不同近切缘距离患者5年生存率的差异均无统计学意义（均P〉0．05）。多因素预后分析显示,浸润深度、淋巴结转移和TNM分期是独立预后影响因素（均P〈0．05）;而胃切除方式并不是独立预后因素（P〉0．05）。结论胃中部癌患者如果能够达到根治手术的要求,其预后不受胃切除方式的影响,行远端胃大部切除术是可行的。     

胃癌并局限型肝转移同步切除九例报告

目的探讨同步切除治疗胃癌并局限型肝转移的临床效果。方法回顾性分析胃癌并局限型肝转移行同步切除的9例患者的临床资料。结果行根治性远端胃大部分切除术7例,根治性近端胃大部分切除术1例,根治性全胃切除1例;局部肝切除8例,左半肝切除1例。无手术死亡病例。术后生存期分别为9、12、12、13、21、24、30、37和62个月,平均生存24.3个月。术后6例再发残肝转移。死亡原因中,3例死于残肝转移,3例死于腹膜转移。结论对胃癌并局限型肝转移患者施行原发灶根治性切除和肝转移灶同步切除可有效地延长生命。     

Clinical Significance of Tumor Location in Remnant Gastric Cancers Developed after Partial Gastrectomy for Primary Gastric Cancer

We sought to elucidate the clinical value of tumor location of the remnant gastric cancer developed after partial gastrectomy for gastric cancer to determine the disease characteristics and surgical outcome. Fifty-two patients underwent a second operation with a curative intent because of remnant gastric cancer after undergoing partial gastrectomy for gastric cancer between 1995 and 2005. The clinicopathological features of their primary and recurrent diseases, surgical results, and survivals according to tumor sites within the remnant stomach were examined. Tumors that developed at the anastomotic site (n = 27) in remnant stomach favored a female gender, younger age, and unfavorable histological characteristics of primary and recurrent diseases and were also associated with lower tumor resectability than those that developed in the non-anastomotic site (n = 25). The overall 5-year survival rates of patients that experienced an anastomotic recurrence and non-anastomotic recurrence were 36.9 and 95.8% (p = 0.001), respectively, and the overall 5-year survival rates of patients with stage I primary gastric cancer were 83.3 and 100% (p = 0.018) for anastomotic and non-anastomotic recurrence. Tumor location of remnant gastric cancer is an important factor for predicting surgical outcome, but it also reflects the characteristics of primary and recurrent diseases. It is hoped that these results will assist surgeons establishing the treatment plan for remnant gastric cancer.     

淋巴结清扫总数和阴性淋巴结数对根治性远端胃大部切除胃癌患者预后的影响

目的 探讨淋巴结清扫总数和阴性淋巴结数目对根治性远端胃大部切除胃癌患者预后的影响.方法 1995年1月至2004年11月,对634例胃癌患者施行根治性远端胃大部切除手术(R0切除).分析淋巴结清扫总数与阴性淋巴结数目的相关性;对预后因素进行单因素及多因素分析;分析淋巴结清扫总数、阴性淋巴结数目与术后5年生存率的关系.结果 本组591例(93.2%)获得随访,时间5～14年,其中位生存期为62.0个月,术后5年生存率为57.6%.淋巴结清扫总数与阴性淋巴结数目的相关性具有统计学意义(P＜0.05).肿瘤浸润深度、阳性及阴性淋巴结数目和淋巴结清扫总数是影响本组患者预后的独立因素.相同TNM分期中,患者的术后5年生存率有随淋巴结清扫总数和阴性淋巴结数目增加而增高的趋势且具有统计学意义(P＜0.05).线性回归预测,淋巴结清扫总数每增加l0枚,患者术后5年生存率都有不同程度的提高:全组为13.1%、Ⅰ期为14.2%、Ⅱ期为20.5%、Ⅲ期为17.5%和Ⅳ期为10.9%;而每多清扫10枚阴性淋巴结,患者术后5年生存率亦可提高:全组为19.2%、Ⅰ期为20.1%、Ⅱ期为18.8%、Ⅲ期为18.4%和Ⅳ期为18.0%.结论 淋巴结清扫总数和阴性淋巴结数目可反映胃癌淋巴结清扫的程度并预测患者预后,应努力增加根治性远端胃大部切除胃癌患者的淋巴结清扫总数和阴性淋巴结数目,以提高远期疗效.     

Gastric remnant necrosis following splenic infarction after distal gastrectomy in a gastric cancer patient

INTRODUCTIONDistal gastrectomy with lymph node dissection is the standard treatment for gastric cancer. Remnant gastric necrosis after distal gastrectomy is very rare and fatal complication.PRESENTATION OF CASEA-78-year-old male diagnosed with advanced gastric cancer underwent distal gastrectomy with lymph node dissection. Postoperative gastric remnant necrosis occurred following splenic infarction. There was thought to be an insufficient blood supply to the gastric remnant due to the lymph node dissection along the proximal splenic artery during the initial surgery. Non-contrast abdominal computed tomography did not reveal any necrosis in the remnant stomach. An endoscopic examination confirmed this diagnosis. Total remnant gastrectomy was performed, and the patient thereafter successfully recovered.DISCUSSIONCareful management of blood vessels and lymph node dissection above the pancreas should be performed to avoid restricting the blood flow and also to prevent gastric remnant necrosis.CONCLUSIONThe knowledge of this fatal complication is crucial for management of postoperative complication. For early and accurate diagnosis, upper gastrointestinal endoscopy is necessary in case of remnant gastric necrosis.     

Alpha-Fetoprotein-Producing Early Gastric Cancer of the Remnant Stomach: Report of a Case

A 67-year-old man initially underwent a distal gastrectomy for early gastric cancer (T1, N0, M0; Stage IA) in March 1995. During the follow-up period, an elevation of the serum α-fetoprotein (AFP) level (98.8 ng/ml) and a liver tumor (S4) were detected. A left hepatectomy was performed in December 1996. Immunohistochemically, AFP-positive cells were present in both the primary gastric tumor and metastasized liver tumor. The serum AFP level normalized immediately, but it elevated again to 22.4 ng/ml. An endoscopic examination revealed a protruding lesion in the remnant stomach. A total resection of the remnant stomach was performed in February 2005. The tumor was evaluated T1, N0, M0; Stage IA, with positive staining for AFP. The patient has survived without any sign of recurrence for more than 11 years after the first diagnosis of cancer. To the best of our knowledge, this is the first case of a long-term survival of AFP-producing gastric cancer with successfully resected metachronous liver metastasis and gastric remnant carcinoma.     

Is detection of asymptomatic recurrence after curative resection associated with improved survival in patients with gastric cancer?

BACKGROUND: It is not clear if more intense surveillance is associated with improved survival after curative resection for cancer. In the context of a followup program after curative gastrectomy, recurrence and survival were investigated for patients presenting with either symptomatic or asymptomatic recurrence. STUDY DESIGN: A prospectively maintained gastric cancer database was used to identify all patients who underwent a curative (R0) gastrectomy from July 1985 to June 2000. Survival curves were generated for patients with either symptomatic or asymptomatic recurrence, and the prognostic variables associated with outcomes were identified. RESULTS: Of 1,172 patients who underwent a curative (R0) gastrectomy, 561 patients (48%) had documented recurrence and 382 patients had complete data about symptoms. Median time to recurrence was 10.8months for asymptomatic patients and 12.4months for symptomatic patients (p = NS). Median postrecurrence survival was 13.5months for asymptomatic patients and 4.8months for symptomatic patients (p < 0.01). Median disease-specific survival was 29.4months for asymptomatic patients and 21.6months for symptomatic patients (p < 0.05). Variables predictive of poor postrecurrence survival included symptomatic recurrence, advanced stage (III/IV), poor differentiation, short disease-free interval (<12months), and multiple sites of recurrence. CONCLUSIONS: Followup did not identify asymptomatic recurrence earlier than symptomatic recurrence. Patients with symptomatic recurrence have more aggressive disease with a shorter postrecurrence survival. The impact of detecting asymptomatic recurrence in the course of followup after curative gastrectomy could not be distinguished from the effects of four powerful biologic variables that also interact to govern outcomes.     

Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery

Background

Completion total gastrectomy for remnant gastric cancer (RGC) is technically challenging, especially using the minimally invasive approach. Only a few small case series have reported the technical feasibility of completion total gastrectomy by minimally invasive surgery (MIS). The aim of this study was to compare the efficacy and safety of MIS and open surgery for RGC.

Methods

We retrospectively analyzed 76 completion total gastrectomies for RGC between 2005 and 2012. Indications for MIS were limited to no evidence of serosa invasion or lymph node metastasis to extraperigastric areas on preoperative evaluation. We compared patient characteristics, intraoperative factors, post-operative outcomes, and survival for the MIS and open surgery groups.

Results

Eighteen patients underwent completion total gastrectomy with MIS (10 laparoscopic, 8 robotic) and 58 patients underwent open surgery. Operation time was longer in the MIS than the open group (266 vs. 203 min, P = 0.004), but the groups had similar estimated blood loss, frequency of unplanned other organ resection, and number of retrieved lymph nodes. The MIS group had a significantly earlier initiation of soft diet, shorter hospital stay, and fewer pain medication injections. Complication rates, recurrence, and overall 5-year survival were similar for the two groups. When we compared laparoscopy with robotic, similar result was shown in all parameters except operation time.

Conclusions

Compared to open surgery, MIS for RGC demonstrated better short-term outcome and comparable oncologic results. MIS for RGC is feasible and safe and maintains advantages of minimal invasiveness. Both laparoscopic and robotic approaches are reasonable to the management of RGC.     

Laparoscopy-assisted distal gastrectomy with laparoscopic sentinel lymph node biopsy after endoscopic mucosal resection for early gastric cancer

Background There has been a trend toward minimally invasive treatment of early gastric cancer. We report the preliminary results of laparoscopy-assisted distal gastrectomy with laparoscopic sentinel lymph node biopsy after endoscopic mucosal resection. Methods Six patients underwent laparoscopy-assisted distal gastrectomy after endoscopic mucosal resection between February 2002 and October 2005 at Mie University Hospital. These patients first underwent laparoscopic sentinel lymph node biopsy and then laparoscopy-assisted distal gastrectomy with lymphadenectomy. Results No patient underwent conversion to open surgery during the operation. None of the patients had any postoperative complications. The mean length of postoperative hospital stay was 11.3 days. Sentinel lymph nodes were identified laparoscopically in five patients. There were 20 sentinel and 85 nonsentinel lymph nodes in the six patients. Postoperatively, tissue sections showed that none of the lymph nodes were metastasized. Immunohistochemistry with D2-40 antibody showed that there were normal lymphatics in the submucosal layer with mucosal defects at the endoscopic mucosal resection site. No patients had any tumor recurrence during followup. Conclusions Laparoscopy-assisted distal gastrectomy after endoscopic mucosal resection was a safe and curative procedure. Endoscopic mucosal resection before sentinel lymph node biopsy was acceptable for early gastric cancer.     

Gastric remnant cancer: an old problem with novel concerns

Background and aims  The patients with cancers in the remnant stomachs after previous partial resections for benign diseases constitute a peculiar subset of the patients with gastric cancer. They are generally at advanced stages on admissions due to disregarding the symptoms related to cancer. Patients and methods  Twenty six patients with cancer arising from the remnant stomach were analyzed. Clinicopathologic features such as age, gender, time interval between the initial operation and diagnosis of gastric remnant cancer, preoperative symptoms, surgical management, and tumor characteristics like size, location, histopathology, depth of invasion, lymph node involvement, presence of distant metastasis, and stages were documented. Results  None of the cancers were diagnosed by routine surveillance and all the patients were symptomatic at the time of diagnosis. Twenty five patients were qualified for surgery. The resectability rate was 61% (n = 16). The ability to perform a curative resection and tumor location at the anastomotic site were determined as the factors significantly influencing survival (p < 0.05). Conclusion  Curative resection has to be the goal of surgical management in patients with gastric remnant cancer. Concerning clinician should be sceptical about a newly developing cancer in order to detect it in an early stage and enhance resectability.     

胃体癌切除范围对预后影响的临床研究

目的：探讨胃体癌切除范围对预后的影响。方法：回顾性分析2003年4月―2008年4月157例行胃体癌根治性手术患者的临床资料和随访资料,其中行全胃切除术的患者104例（全胃组）,行远端胃次全切除术53例（远端胃组）,对比两组的5年生存率,分析胃体癌预后的独立影响因素。结果：全组患者5年生存率为37.6%,其中全胃组、远端胃组5年生存率分别为24.0%、64.2%,全胃组明显低于远端胃组（χ2=10.635,P=0.001）;为消除两组术前基线资料的差异,将TNM分期分层对比的结果显示,低TNM分期患者中,远端胃组生存率明显高于全胃组（P<0.05）,而高TNM分期患者中,两组生存率差异无统计学意义（P>0.05）。COX回归模型分析结果显示,TNM分期（HR=1.270,95% CI=1.093~2.344）、肿瘤分化程度（HR=1.764,95% CI=1.372~2.746）是胃体癌预后的独立影响因素（均P<0.05）, 而切除范围（HR=0.547,95% CI=0.320~1.076）不是胃体癌预后的独立影响因素（P>0.05）。结论：手术切除范围并非胃体癌预后的独立影响因素,在保证根治性的前提下远端胃次全切除术是更为适宜的术式。