Alexandrou Andreas, Davis Peter A, Law Simon, Whooley Brian P, Murthy Sudish C, Wong John
Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China.
Arch Surg. 2002 Nov;137(11):1238-42. doi: 10.1001/archsurg.137.11.1238.
There is an association between a history of distal gastrectomy and the development of esophageal cancer. Surgical treatment of esophageal cancer in patients with a history of gastrectomy is more complicated but will not result in increased mortality in an experienced center.
Case-control study.
Tertiary care center for the treatment of esophageal cancer.
Forty patients with a history of gastrectomy and 1266 patients with intact stomachs who underwent esophagectomy for cancer.
Patients' demographic characteristics, tumor characteristics, operative morbidity, mortality, and long-term survival.
There were more squamous tumors located in the lower third of the esophagus in those who had a history of gastrectomy compared with those with intact stomachs (16 [41%] of 40 patients vs 318 [25%] of 1266 patients; P=.04). This difference was more pronounced after Billroth I vs Billroth II gastrectomy (8 [73%] of 11 patients vs 8 [29%] of 28 patients; P=.03). Twenty-four patients (60%) in the gastrectomy group and 738 (58%) in the nongastrectomy group underwent surgical resection (P=.87). The operative time (300 [160-465] vs 220 [90-520] minutes; P<.001) was longer and more blood loss (1000 [300-2500] vs 700 [150-7000] mL;P<.001) was encountered for esophagectomy after previous gastrectomy (data are given as median [range]). A colon interposition was the substitute conduit of choice in the gastrectomy group (20 [83%] of 24 patients), and the stomach was the preferred loop in those with intact stomachs (729 [99%] of 738 patients). Postoperative complication rates were similar. In-hospital mortality rates also did not differ for those with a history of gastrectomy vs those without such a history (12% for both,P>.99). Median survival after resection was 13.8 and 12.5 months for patients who did and did not undergo prior gastrectomy, respectively (P=.62).
A history of gastrectomy (especially the Billroth I type) is associated with more lower-third squamous cell esophageal carcinomas. Surgical resections in patients with such a history were more complicated but resulted in similar outcomes.
远端胃切除术史与食管癌的发生之间存在关联。有胃切除术史的食管癌患者的手术治疗更为复杂，但在经验丰富的中心不会导致死亡率增加。
病例对照研究。
食管癌治疗的三级医疗中心。
40例有胃切除术史的患者和1266例接受食管癌切除术的胃完整的患者。
患者的人口统计学特征、肿瘤特征、手术发病率、死亡率和长期生存率。
有胃切除术史的患者与胃完整的患者相比，食管下三分之一处的鳞状肿瘤更多（40例患者中有16例[41%]，而1266例患者中有318例[25%]；P = 0.04）。毕罗Ⅰ式胃切除术后与毕罗Ⅱ式胃切除术后这种差异更为明显（11例患者中有8例[73%]，而28例患者中有8例[29%]；P = 0.03）。胃切除组24例患者（60%）和非胃切除组738例患者（58%）接受了手术切除（P = 0.87）。既往有胃切除术的患者行食管癌切除术的手术时间更长（300[160 - 465]分钟对220[90 - 520]分钟；P < 0.001），失血量更多（1000[300 - 2500]毫升对700[150 - 7000]毫升；P < 0.001）（数据以中位数[范围]表示）。胃切除组中结肠间置是首选的替代管道（24例患者中有20例[83%]），胃完整的患者中胃是首选的肠袢（738例患者中有729例[99%]）。术后并发症发生率相似。有胃切除术史的患者与无胃切除术史的患者的院内死亡率也无差异（均为12%，P > 0.99）。切除术后有和没有既往胃切除术的患者的中位生存期分别为13.8个月和12.5个月（P = 0.62）。
胃切除术史（尤其是毕罗Ⅰ式）与更多的食管下三分之一鳞状细胞癌相关。有这种病史的患者的手术切除更为复杂，但结果相似。
