胃癌手术切断端癌残留的临床特点及预防

Clinical characteristics and prevention of positive stump in gastric cancer

This paper summarizes 80 cases with positive stump among 946 cases of gastric cancer treated by gastrectomy from 1962 to 1986. The positive stump rate was much higher at the esophageal than the duodenal end (12.5% vs 4.5%). It was related to gross type and size of cancer (P less than 0.01). In lesions larger than 5 cm in diameter and of infiltrating type, especially the superficially spreading early cancers by which the gastric mucosa was infiltrated extensively without any clear margin, it was difficult to identify the extent of infiltration and cancer residue due to inadequate resection was likely. In order to avoid a positive stump, 1. total gastrectomy is indicated for cancer of the gastric body or infiltrating type, 2. super-subtotal gastrectomy including the whole lesser curvature or total gastrectomy is indicated for localized lesions larger than 5 cm in diameter at the antrum, and 3. for proximal cancers, the resection line should be set in the esophagus 5 cm beyond the tumor margin and routine examination of the resected specimen should be done during the operation.