Han Shao-Liang, Hua Ya-Wei, Wang Cheng-Hu, Ji She-Qing, Zhuang Jing
Department of General Surgery, Henan Tumor Hospital, Zhengzhou City, Henan Province, People's Republic of China.
J Surg Oncol. 2003 Apr;82(4):241-6. doi: 10.1002/jso.10228.
Metastatic pattern of lymph node (LN) and surgery options for gastric stump cancer (GSC) remain controversial. The aim of this study was to investigate LN metastasis and lymphadenectomy for GSC for curative purposes.
Sixty-seven patients with GSC were analyzed retrospectively.
The metastatic rates of LN were as follows: 63.3% in right cardia (No. 1), 33.3% in left cardia (No. 2), 75.0% in lesser curvature (No. 3), 53.3% in greater curvature (No. 4), 40.0% in celiac artery (No. 9), 60.0% in splenic hilus (No. 10), 72.7% in splenic artery (No. 11), 36.1% in hepatoduodenal ligament (No. 12), 8.3% in retropancreatic (No. 13), 21.4% in para-aortic (No. 16), 50% in supra-diaphragm (No. 111), 16.7% in LN within jejunal mesentery, respectively. All nine patients who only received simple laparotomy died within 1 year. The overall 5-year survival rate of GSC was 17.9% (12/67), including 100% for stage I, 80.0% for stage II, 12.1% for stage III, and 0% for stage IV. Moreover, the 5-year survival rate (36.7%, 11/30) for curative patients was significantly better than that (3.6%, 1/28) of non-curative patients (chi(2) = 7.76, P < 0.01).
Our results imply that GSC has a wide range of LN metastases, including LN within jejunal mesentery in B-II reconstruction cases, and curable resection may obtain better results. Therefore, we suggest that radical operation for B-I patients needs removal of gastroduodenectomy anastomosis and the above LNs, and that B-II patients need removal of 10 cm of jejunum besides gastrojejunostomy anastomosis, and clearance of LN within its mesentery, in addition to B-I GSC.
胃残端癌（GSC）的淋巴结转移模式及手术方式仍存在争议。本研究旨在探讨GSC的淋巴结转移情况及为根治目的进行的淋巴结清扫术。
对67例GSC患者进行回顾性分析。
各部位淋巴结转移率如下：贲门右区（第1组）为63.3%，贲门左区（第2组）为33.3%，胃小弯（第3组）为75.0%，胃大弯（第4组）为53.3%，腹腔动脉周围（第9组）为40.0%，脾门（第10组）为60.0%，脾动脉（第11组）为72.7%，肝十二指肠韧带（第12组）为36.1%，胰后（第13组）为8.3%，腹主动脉旁（第16组）为21.4%，膈上（第111组）为50%，空肠系膜内淋巴结为16.7%。仅接受单纯剖腹手术的9例患者均在1年内死亡。GSC患者的总体5年生存率为17.9%（12/67），其中I期为100%，II期为80.0%，III期为12.1%，IV期为0%。此外，根治性切除患者的5年生存率（36.7%，11/30）显著高于非根治性切除患者（3.6%，1/28）（χ² = 7.76，P < 0.01）。
我们的结果表明，GSC存在广泛的淋巴结转移，包括B-II重建病例中空肠系膜内的淋巴结，可切除性手术可能会取得更好的效果。因此，我们建议，对于B-I型患者的根治性手术需要切除胃十二指肠吻合口及上述淋巴结，对于B-II型患者，除了胃空肠吻合口外，还需要切除10 cm空肠，并清扫其系膜内的淋巴结，此外还需按照B-I型GSC的手术方式进行。
