早期胃癌远端胃次全切除术后的残胃癌：541例长期随访患者的经验

Gastric stump carcinoma after distal subtotal gastrectomy for early gastric cancer: experience of 541 patients with long-term follow-up.

作者信息

Morgagni Paolo, Gardini Andrea, Marrelli Daniele, Vittimberga Giovanni, Marchet Alberto, de Manzoni Giovanni, Di Cosmo Maria Antonietta, Rossi Gian Maria, Garcea Domenico, Roviello Franco

机构信息

Department of General Surgery, Morgagni-Pierantoni Hospital, via Carlo Forlanini 34, 47121 Forlì, Italy.

出版信息

Am J Surg. 2015 Jun;209(6):1063-8. doi: 10.1016/j.amjsurg.2014.06.021. Epub 2014 Aug 7.

DOI:10.1016/j.amjsurg.2014.06.021

PMID:25218580

Abstract

BACKGROUND

Gastric stump carcinoma (GSC) has been studied after primary gastrectomy for benign disease but few studies have evaluated its correlation with gastric cancer.

PATIENTS

We assessed 541 patients submitted to subtotal gastrectomy for early gastric cancer at least 15 years ago.

RESULTS

GSC was diagnosed in 16 (2.9%) patients, giving a 4% cumulative risk of GSC 20 years after surgery. Diagnosis was made within 5 years of surgery in 10 patients and after 8 years in 6 cases. GSC occurred in 13/470 (2.8%) patients submitted to Billroth 2 reconstruction, 2/30 (6.7%) patients who underwent Billroth 1, and 1/41 (2.4%) patients after Roux-en-Y reconstruction. Significant risk factors observed for GSC were histologic type and sex. Other synchronous or metachronous extragastric tumors were registered in 56 (11.2%) patients.

CONCLUSIONS

The risk of GSC was low, even 20 years after subtotal gastrectomy for early gastric cancer. Lauren intestinal histotype and male sex were frequently associated with GSC. No correlation was observed between GSC and reconstruction technique or multifocality. Clinically speaking, GSC could be considered a subset of gastric cancer.

摘要

背景

胃残端癌（GSC）已在因良性疾病行初次胃切除术后得到研究，但很少有研究评估其与胃癌的相关性。

患者

我们评估了至少15年前因早期胃癌接受胃大部切除术的541例患者。

结果

16例（2.9%）患者被诊断为胃残端癌，术后20年胃残端癌的累积风险为4%。10例患者在术后5年内确诊，6例在术后8年确诊。在接受毕Ⅱ式重建的470例患者中有13例（2.8%）发生胃残端癌，接受毕Ⅰ式手术的30例患者中有2例（6.7%），接受Roux-en-Y重建的41例患者中有1例（2.4%）。观察到的胃残端癌的显著风险因素是组织学类型和性别。56例（11.2%）患者存在其他同时性或异时性胃外肿瘤。