Sinning C, Schaefer N, Standop J, Hirner A, Wolff M
Department of Surgery, University of Bonn, Sigmund-Freud-Strasse 25, Bonn D-53105, Germany.
Eur J Surg Oncol. 2007 Mar;33(2):133-9. doi: 10.1016/j.ejso.2006.09.006. Epub 2006 Oct 30.
The aim of this article is to review the aetiology, pathology and treatment of gastric stump carcinoma (GSC). GSC is an uncommon tumour; however, the incidence is not declining, so this tumour entity will be encountered in the years to come.
The electronic literature search was performed in the MEDLINE database to identify relevant studies concerning epidemiology, prognosis, treatment, aetiology and pathology of GSC. The references reported in these studies were used to complete the literature search.
Patients subjected to distal gastric resection have a 4-7-fold increased risk of developing GSC, which is attributed mainly to gastroduodenal reflux. Denervation during partial gastrectomy may also contribute to the risk of developing GSC. Gastroduodenal ulcers were the main reason for partial gastrectomy. Both ulcer locations have an increased risk of developing GSC after 20 years. In GSC, Helicobacter pylori seems not to be an important risk factor, contrary to primary gastric cancer, because gastroduodenal reflux impairs the growth of Helicobacter pylori.
The treatment of choice for GSC should be the total removal of the gastric remnant including at least D2 lymphadenectomy. The pattern of lymph node metastases in GSC may differ from primary gastric cancer, as lymph node metastases have been reported in the jejunal mesentery and the lower mediastinum. Therefore, GSC may require a modified lymphadenectomy to include all important lymph node stations. After radical remnant gastrectomy, GSC has a prognosis not different from primary proximal gastric cancer.
本文旨在综述残胃癌（GSC）的病因、病理及治疗。GSC是一种罕见肿瘤；然而，其发病率并未下降，因此在未来数年仍会遇到这种肿瘤类型。
在MEDLINE数据库中进行电子文献检索，以识别有关GSC的流行病学、预后、治疗、病因及病理的相关研究。这些研究中报告的参考文献用于完成文献检索。
接受远端胃切除术的患者发生GSC的风险增加4至7倍，这主要归因于胃十二指肠反流。部分胃切除术中的去神经支配也可能增加发生GSC的风险。胃十二指肠溃疡是部分胃切除术的主要原因。两种溃疡部位在20年后发生GSC的风险均增加。在GSC中，与原发性胃癌相反，幽门螺杆菌似乎不是一个重要的危险因素，因为胃十二指肠反流会损害幽门螺杆菌的生长。
GSC的首选治疗方法应是完全切除胃残余组织，至少包括D2淋巴结清扫术。GSC的淋巴结转移模式可能与原发性胃癌不同，因为已报道在空肠系膜和下纵隔有淋巴结转移。因此，GSC可能需要改良的淋巴结清扫术以包括所有重要的淋巴结站。根治性残胃切除术后，GSC的预后与原发性近端胃癌无异。
