Gnanalingham K K, Hall C N, Bishop P
Department of Surgery, Wythenshawe Hospital, South Manchester University Hospitals Trust, Manchester, UK.
J R Coll Surg Edinb. 1999 Feb;44(1):61-2.
Whilst synchronous adenocarcinoma of the stomach is well documented, metachronous primary disease is exceedingly rare. We report a man with a family history of colonic and gastric cancer, who underwent a resection of a Duke's C adenocarcinoma of the rectum, aged 56 years, and a proximal partial gastrectomy for synchronous stage 1 gastric adenocarcinomas of the lesser curve, aged 61 years. Nine years later, a metachronous gastric primary was discovered in the gastric remnant, necessitating total gastrectomy. Total gastrectomy is the operation of choice for synchronous gastric primaries as it ensures clearance and prevents metachronous growth. However, it may not be appropriate for all gastric cancer as operative morbidity and mortality are increased, and because synchronicity and metachronicity of gastric cancer are uncommon. Moreover, there are no consistent data to demonstrate a survival advantage for total compared with partial gastrectomy for operable gastric cancer. If, after partial gastrectomy, synchronous disease is detected in the resected specimen (as in this reported case), endoscopic surveillance for metachronous disease is advised, since this may be amenable to surgical cure.
虽然胃同步腺癌已有充分记载，但异时性原发性疾病极为罕见。我们报告了一名有结肠癌和胃癌家族史的男性，他在56岁时接受了直肠癌杜克C期腺癌切除术，61岁时因小弯侧同步1期胃腺癌接受了近端部分胃切除术。九年后，在胃残端发现了异时性原发性胃癌，需要进行全胃切除术。全胃切除术是同步性胃原发性肿瘤的首选手术，因为它能确保切除彻底并防止异时性生长。然而，它可能并不适用于所有胃癌，因为手术发病率和死亡率会增加，而且胃癌的同步性和异时性并不常见。此外，没有一致的数据表明，对于可手术的胃癌，全胃切除术与部分胃切除术相比在生存方面有优势。如果在部分胃切除术后，在切除标本中检测到同步性疾病（如本报告病例），建议对异时性疾病进行内镜监测，因为这可能适合手术治愈。
