胃癌术后复发转移部位分析及其对术后治疗的意义

 目的　总结胃癌术后复发转移类型和部位，探讨胃癌术后预防性治疗的方法。方法　回顾性分析2001年1月至2009年8月162例胃癌根治术后出现复发转移的患者，复发转移均经超声、CT或MRI检查进行诊断，34例腹腔积液中有15例经病理学诊断，所有浅表淋巴结及腹壁转移均经穿刺细胞病理学证实，31例残胃和吻合口复发均由病理组织学证实。结果　162例中63例为多部位复发转移，其中腹腔淋巴结转移76例（46.9 %），腹膜转移34例（21.0 %），残胃和（或）吻合口复发31例（19.1 %），肝脏转移31例（19.1 %），其他部位发生率均＜10 %。在76例腹腔淋巴结转移患者中，胃周淋巴结转移37例（48.7 %），胰周淋巴结转移24例（31.6 %），腹主动脉旁淋巴结转移15例（19.7 %）；其中97例原发于胃底贲门癌患者腹腔淋巴结转移56例（57.7 %），48例原发于胃体部的胃癌患者腹腔淋巴结转移29例（60.4 %），胃窦部的胃癌患者腹腔淋巴结转移11例（64.7 %）。结论　胃癌根治术后局部复发主要发生在残胃和（或）吻合口、腹腔淋巴结及腹腔、盆腔的种植转移， 腹腔淋巴结以胃周、胰周和腹主动脉旁淋巴结转移多见；远处转移的部位主要为肝、肺、脑、椎骨、颈部及纵隔淋巴结等。胃癌术后的治疗应以预防局部复发和远处转移为主，进行全身化疗、腹腔灌注化疗及联合局部区域的放疗。预防性放疗的范围应包括残胃、吻合口及胃周、胰周和腹主动脉旁淋巴结区域。

Analysis of sites for recurrent and metastatic gastric cancer after curative resection and its guidances for the treatment

Objective To investigate the patterns for the recurrent and metastatic gastric cancer after curative resection and to indicate the strategy of treatment. Methods 162 patients who had received radical resection and presented post-operation failure during recent 9 years were analyzed. The failure patterns were confirmed by type-B ultrasonic or CT / MRI imaging. 15 of 34 patients with abdominal dropsy were diagnosed by adenocarcinoma cells in the abdominal dropsy. All superficial lymphadens and abdominal wall metastasis were diagnosed via punctuation. 31 patients with gastric remnant and (or) anastomoses recurrence were diagnosed via biopsy. Results Of 162 patients, 63 presented the recurrence or metastasis in multiple sites,including abdominal lymph node (LN) metastases in 46.9 % (76/162), peritoneum metastases in 21.0 % (34/162),gastric remnant and (or) anastomoses recurrence in 19.1% (31/162), liver metastases in 19.1% (31/162), the incidence rates of other parts were all ＜10 %. Meanwhile, out of 76 patients with abdominal lymph node metastases, 48.7 % (37/76) patients with peri-gastric LNs metastases, 31.6 % (24/76) with peri-pancreatic LNs metastases, 19.7 % (15/76) with para-aortic LNs metastases. The incidence of LN metastases was 57.7 % (56/97) in cancer arising from gastric fundus/cardia and 60.4% (29/48) in gastric body and 64.7 % (11/17) in pylorus antrum. Conclusion The regional failure sites for gastric cancer patients with radical resection were dominantly found in the gastric stump/stoma, the peritoneum and pelvic cavity implantation and abdominal cavity LN metastases, especially in the peri-gastric, peri-pancreatic and/or para-aortic LN metastases. The distant place failure sites were mainly in the liver, lung, brain, spondylus, cervical part LN and mediastinal LN metastases. Therefore, we should take chemotherapy, abdominal cavity chemotherapy and regional radiotherapy to prevent the regional district recurrences and distant metastasis after the gastric cancer patients with radical resection. Radiotherapy fields should focus on the gastric stump/stoma and the peri-gastric, peri-pancreatic and para-aortic LN regions.