Kassahun Woubet T, Lamesch Peter, Wittekind Christian, Neid Matthias, Schneider Jens P, Mössner Joachim, Hauss Johann
Department of Surgery II, University of Leipzig, Liebig Strasse 20, 04103 Leipzig, Germany.
Clin Med Oncol. 2008;2:109-12. doi: 10.4137/cmo.s384. Epub 2008 Mar 27.
The development of malignancy in the gastric stump following surgery for peptic ulcer disease is well recognized. There are also few reports on carcinomas occurring after surgery for malignant gastric disease. However, carcinoma of the gastric stump after duodenopancreatectomy is extremely rare. We describe what we believe to be an unusual case of signet-ring cell carcinoma of the gastric stump developing at the anastomotic site 5 years after duodenopancreatectomy for ductal adenocarcinoma of the pancreatic head. We performed remnant gastrectomy and Roux-en-Y gastrojejunostomy as a curative resection. This experience clearly underlies that g astric stump carcinoma (GSC) may mimic metastatic disease recurrence leading to diagnostic confusion after surgery for malignancy. Although an increased risk of gastric stump carcinoma after pancreatoduodenectomy for pancreatic cancer has not been established, the possibility of such a complication should be kept in mind when evaluating patients after gastric resection who present with symptoms of metastatic disease recurrence years after the primary operation. Investigations should be independent of the entity of the primary disease or its localization, since GSC may well be amenable to surgical cure as demonstrated in the presented case. Outpatient follow up results of the last four years indicated no recurrence in this case.
消化性溃疡病手术后胃残端发生恶性肿瘤已得到充分认识。关于恶性胃病手术后发生癌症的报道也很少。然而，十二指肠胰切除术后胃残端癌极为罕见。我们描述了一例我们认为不寻常的病例，即一名患者在因胰头导管腺癌接受十二指肠胰切除术后5年，吻合口处发生胃残端印戒细胞癌。我们进行了残胃切除术和Roux-en-Y胃空肠吻合术作为根治性切除术。这一经验清楚地表明，胃残端癌（GSC）可能类似转移性疾病复发，导致恶性肿瘤手术后的诊断混乱。虽然胰腺癌胰十二指肠切除术后胃残端癌风险增加尚未得到证实，但在评估初次手术后数年出现转移性疾病复发症状的胃切除患者时，应牢记这种并发症的可能性。检查应独立于原发疾病的实体或其定位，因为正如本病例所示，胃残端癌很可能通过手术治愈。过去四年的门诊随访结果表明该病例无复发。
