Department of General and Gastroenterological Surgery, Osaka Medical College, 17-2, Daigaku-Machi, Takatsuki City, Osaka, 569-8686, Japan.
World J Surg. 2010 Jul;34(7):1540-7. doi: 10.1007/s00268-010-0505-5.
Carcinoma of the gastric remnant after partial gastrectomy for benign disease or cancer is unusual but an important cancer model. The Japanese Society for the Study of Postoperative Morbidity after Gastrectomy (JSSPMG) performed a nationwide questionnaire survey to understand the current state of gastric stump carcinoma in Japan.
In the questionnaire survey of November 2008, gastric stump carcinoma was defined as an adenocarcinoma of the stomach occurring 10 years or more after Billroth I or Billroth II gastrectomy for benign condition or cancer disease. The survey was conducted at the request of reports on five or more patients with gastric stump carcinoma for each institution. Items for the survey included gender, age, methods of reconstruction in an original gastrectomy, original diseases, time interval between original gastrectomy and first detection of stump carcinomas, locations of stump carcinomas, tumor histology, tumor depth, and extent of lymph node metastasis. The questionnaire was sent to 163 surgical institutions in the JSSPMG.
Ninety-five institutions (58.3%) responded to the survey, and the data of 887 patients satisfied the required conditions for the survey. A total of 887 patients were composed of 368 patients who received Billroth I distal gastrectomy and 519 who received Billroth II. The Billroth II group has a significantly higher number of original benign lesions than the Billroth I group (P < 0.001). This study confirmed the following issues: (1) The remnant stomach after gastrectomy for cancer disease had a higher prevalence to develop stump carcinomas occurring in a shorter time interval since original gastrectomy; (2) Patients with Billroth II gastrectomy had stump carcinomas most frequently in the anastomotic area, but not in the non-stump area as in Billroth I gastrectomy; (3) Tumor histology of 72.4% of 304 stump carcinomas at an early stage was intestinal type adenocarcinoma, i.e., well or moderately differentiated adenocarcinoma, whereas it decreased to 42.2% at the locally advanced stage of 521 stump carcinomas (P = 0.0015), suggesting that stump carcinoma mostly may develop from intestinal type and change to diffuse type during the evolution to advanced stage cancers.
This large series of surveys suggest that there are two distinct biological plausibilities in the development of gastric stump carcinoma: (1) it develops in a shorter time interval of 10 years or less since the original gastrectomy, may come from a higher risk of gastric mucosa after gastrectomy for cancer diseases that highly predisposes to cancer, and (2) it develops during a longer time interval of 20 years or more, may come from gastrectomy-relating mechanisms after gastrectomy for original benign diseases.
胃大部切除术后良性疾病或癌症的残胃癌并不常见，但却是一种重要的癌症模型。日本胃癌术后并发症研究学会（JSSPMG）进行了一项全国性问卷调查，以了解日本残胃癌的现状。
在 2008 年 11 月的问卷调查中，残胃癌被定义为 Billroth I 或 Billroth II 胃大部切除术后 10 年以上发生的胃腺癌，用于良性或癌症疾病。该调查是应每家机构报告 5 例或更多残胃癌患者的要求进行的。调查项目包括性别、年龄、原胃大部切除术中的重建方法、原发病、原胃大部切除术后与首次发现残胃癌之间的时间间隔、残胃癌的部位、肿瘤组织学、肿瘤深度和淋巴结转移程度。该问卷被发送到 JSSPMG 的 163 个外科机构。
95 个机构（58.3%）对调查做出了回应，887 名患者的数据符合调查要求。共有 887 名患者，其中 368 名接受 Billroth I 远端胃大部切除术，519 名接受 Billroth II 术式。Billroth II 组的原始良性病变数量明显多于 Billroth I 组（P<0.001）。本研究证实了以下问题：（1）癌症术后的残胃发生残胃癌的时间较短，且更易发生；（2）Billroth II 胃大部切除术后吻合口处残胃癌最常见，但 Billroth I 胃大部切除术后残胃癌不发生于残胃非吻合口处；（3）304 例早期残胃癌的肿瘤组织学类型中，72.4%为肠型腺癌，即高或中分化腺癌，而 521 例局部晚期残胃癌的肿瘤组织学类型则降至 42.2%（P=0.0015），提示残胃癌可能主要来源于肠型，在向晚期癌症发展过程中向弥漫型转化。
这项大规模调查表明，残胃癌的发生有两种不同的生物学可能性：（1）残胃癌发生在原胃大部切除术后 10 年或更短的时间内，可能来自于癌症术后残胃的高风险黏膜，使残胃癌更易发生；（2）残胃癌发生在 20 年或更长的时间内，可能来自于原良性疾病胃大部切除术后的与胃切除术相关的机制。
