Staël von Holstein C, Eriksson S, Hammar E
Department of Surgery, Lund University, Sweden.
Br J Surg. 1991 Oct;78(10):1238-41. doi: 10.1002/bjs.1800781029.
Between 1971 and 1990, 26 patients were diagnosed as having an early carcinoma in the gastric remnant after ulcer surgery. Three patients with proximal tumour location were operated on with total gastrectomy. The surgical strategy in the remaining patients with tumour adjacent to the anastomosis was re-resection of at least 5-6 cm of the anastomotic area and restoration of gastrointestinal continuity with a Roux-en-Y loop. A margin of at least 2 cm from the carcinoma to the resection line was taken. There was no postoperative mortality. In three cases the preoperative endoscopic and histological judgement of tumour classification and stage was incorrect; when the surgical specimens were examined one patient was found to have advanced carcinoma and in the other two no malignancy could be found. Median follow-up was 15 years (range 3-19 years). During follow-up, six of the re-resected patients developed recurrences, all located in the gastric remnant. Four patients with recurrence underwent reoperation with total gastrectomy, one had exploratory laparotomy and one had no further surgery. No postoperative deaths occurred. Three of the six patients died from gastric carcinoma. We conclude that this surgical strategy failed to prevent local recurrence of an early form of gastric carcinoma, considered to be potentially curable in virtually all cases. Partial resection of the gastric remnant as the treatment of choice in patients with early gastric stump carcinoma cannot be recommended.
1971年至1990年间，26例患者在溃疡手术后被诊断为残胃癌早期。3例肿瘤位于近端的患者接受了全胃切除术。其余肿瘤邻近吻合口的患者的手术策略是再次切除至少5 - 6厘米的吻合口区，并采用Roux-en-Y袢恢复胃肠道连续性。从癌肿到切除线的切缘至少为2厘米。无术后死亡病例。3例患者术前内镜及组织学对肿瘤分类和分期的判断有误；检查手术标本时，发现1例患者患有进展期癌，另外2例未发现恶性肿瘤。中位随访时间为15年（范围3 - 19年）。在随访期间，6例再次切除的患者出现复发，均位于残胃。4例复发患者接受了全胃切除再次手术，1例接受了剖腹探查，1例未再进行手术。无术后死亡病例。6例患者中有3例死于胃癌。我们得出结论，这种手术策略未能预防早期胃癌的局部复发，而早期胃癌在几乎所有病例中都被认为是有可能治愈的。不推荐将残胃部分切除术作为早期残胃癌患者的首选治疗方法。
