Irino Tomoyuki, Hiki Naoki, Ohashi Manabu, Nunobe Souya, Tokunaga Masanori, Sano Takeshi, Yamaguchi Toshiharu
Department of Gastroenterological Surgery, Cancer Institute Hospital, Koto-ku, Tokyo, Japan.
Department of Gastroenterological Surgery, Cancer Institute Hospital, Koto-ku, Tokyo, Japan.
Surgery. 2016 Jun;159(6):1539-1547. doi: 10.1016/j.surg.2016.01.003. Epub 2016 Feb 12.
Owing to its relative rarity, the characteristics of gastric stump cancer (GSC) have not been fully understood. In this study, we clarified the detailed characteristics from a large cohort of GSC patients.
For this retrospective cohort study from 1 hospital in Japan, we recruited 262 GSC patients who underwent surgery for GSC between 1984 and 2012. GSC was defined in accordance with Japanese Gastric Cancer Association. Stage was categorized in accordance with the 7th TNM classification for primary gastric cancer.
Although the time interval between the primary and second operations differed significantly depending on the primary disease (34.3 years for benign vs 9.9 years for malignant on average), it did not influence survival. The 5-year overall survival rates of patients with N0, N1, N2, and N3 were 70.4%, 27.7%, 21.8%, and 6.4%, respectively, whereas the rates for those with stage I, II, III, and IV were 77.8%, 37.4%, 18.6%, and 10.5%, respectively. Recurrence in the peritoneum was the most common pattern, followed by recurrence in the local region or lymph nodes. The Cox proportional hazard model demonstrated that age > 65, T stage, N stage, and tumor histology were significant independent prognostic factors for survival, whereas neither primary disease nor primary anastomosis type significantly impacted survival.
Neither primary disease nor anastomosis type affected survival significantly, despite significant differences in their characteristics. In addition, the time interval between the primary and second surgery did not impact survival.
由于胃残端癌（GSC）相对罕见，其特征尚未得到充分了解。在本研究中，我们从一大群GSC患者中阐明了其详细特征。
对于这项来自日本一家医院的回顾性队列研究，我们招募了1984年至2012年间接受GSC手术的262例GSC患者。GSC根据日本胃癌协会的标准定义。分期根据原发性胃癌的第7版TNM分类进行划分。
尽管初次手术与二次手术之间的时间间隔因原发性疾病而异（良性疾病平均为34.3年，恶性疾病平均为9.9年），但这并未影响生存率。N0、N1、N2和N3患者的5年总生存率分别为70.4%、27.7%、21.8%和6.4%，而I期、II期、III期和IV期患者的生存率分别为77.8%、37.4%、18.6%和10.5%。腹膜复发是最常见的复发模式，其次是局部区域或淋巴结复发。Cox比例风险模型显示，年龄>65岁、T分期、N分期和肿瘤组织学是生存的重要独立预后因素，而原发性疾病和原发性吻合类型均未对生存产生显著影响。
尽管原发性疾病和吻合类型的特征存在显著差异，但它们均未对生存产生显著影响。此外，初次手术与二次手术之间 的时间间隔也未影响生存。
