胃癌切除术切端癌残留的病理特点

目的了解胃癌手术切缘癌残留的病理特点，以探讨相应预防对策。方法整理分析1964年12月至2004年12月间胃癌术后108例发生切端残留癌患者的临床资料。结果108例手术切端残留癌患者占同期有完整资料的胃癌手术患者1670例的6．5％。男女比例为1．4：1．0：年龄23～82（中位年龄54）岁。根治性、姑息性胃癌切除术切端残留癌发生率分别为3．6％（48／1333）和17．8％（60／337）（P=0．000）。早期和进展期胃癌切除术切端残留癌发生率分别为2．3％（3／129）和6．8（105／1541）（P=0．046）。远、近端胃癌切除术切端癌残留率分别为4．5％（37／815）和8．0％（55／689）（P=0．000）。胃上部癌、Borrmann Ⅲ、Ⅳ型、进展期癌、癌肿直径大于或等于5cm、低和未分化癌以及癌肿侵破浆膜者，易发生癌残留（均P〈0．05）。结论癌残留与患者病期及肿瘤的Borrmann分型、大小、分化程度和浸润深度有关。

Pathologic characteristics of residual carcinoma at incisal edge after gastrectomy for gastric cancer

Objective To explore the reason, features and preventive measures of residual carcinoma at incisal edge after gastric cancer operation. Methods Clinical data of 108 cases with positive incisal margin (6.47%) from December 1964 to December 2004 in Cancer Center of Sun Yat-sen were summarized and analyzed retrospectively. Results Positive incisal margin patients accounted for 6.5%(108/1670) of total gastric carcinoma cases during above period. There were 62 men and 46 women with median age of 54 years (ranged from 23 to 82). The residual carcinoma rates of incisal edge were 3.6%(48/1333) in radical resection group and 17.8%(60/337) in palliative resection group respectively (P=0.000). Also, the residual carcinoma rates were 2.3%(3/129) in early group, 6.8 (105/1541) in advanced group (P=0.046), 4.5%(37/815)in distal gastrectomy group and 8.0%(55/689) in proximal group respectively (P=0.000). Residual carcinomas were related with pTNM stage, Borrmann type, tumor size, differentiation and invasion depth (P<0.05).Conclusions Superior gastric carcinoma, Borrmann Ⅲ,Ⅳ type advanced cancer, tumor diameter ≥5cm, poor differentiation or undifferentiated type and serosa invaded easily result in residual carcinoma at incisal edge. The radical preventive measure is to ensure that incisal edge ought to exceed 5 cm apart from the tumor.