Ohira Masaichi, Toyokawa Takahiro, Sakurai Katsunobu, Kubo Naoshi, Tanaka Hiroaki, Muguruma Kazuya, Yashiro Masakazu, Onoda Naoyoshi, Hirakawa Kosei
Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
World J Gastroenterol. 2016 Feb 28;22(8):2424-33. doi: 10.3748/wjg.v22.i8.2424.
Remnant gastric cancer (RGC) and gastric stump cancer after distal gastrectomy (DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori (H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.
残胃癌（RGC）和远端胃切除术后（DG）的胃残端癌被视为同一临床实体。在本综述中，介绍了有关残胃癌的现有知识以及尚未解决的问题。十二指肠-胃反流和胃黏膜去神经支配被认为是良性疾病后残胃癌发生的两个主要因素。另一方面，一些在初次手术时就已存在的癌前情况，如萎缩性胃炎和肠化生，是胃癌后残胃癌的主要相关因素。虽然根除残胃中的幽门螺杆菌（H. pylori）很有前景，但它是否能降低癌变风险仍不确定。据报道，远端胃切除术后进行定期内镜监测有助于早期发现残胃癌，这为进行微创内镜治疗或腹腔镜手术提供了机会，并改善了残胃癌患者的预后。未来的挑战可能包括，如果根除幽门螺杆菌能降低残胃癌风险，需阐明其益处；通过对残胃癌发生风险进行分层，制定远端胃切除术后最佳的内镜监测策略；以及通过预测预后，开发特定的残胃癌分期系统，以实现治疗的标准化。
