Son Sang-Yong, Kong Seong-Ho, Ahn Hye Seong, Park Young Suk, Ahn Sang-Hoon, Suh Yun-Suhk, Park Do Joong, Lee Hyuk-Joon, Kim Hyung-Ho, Yang Han-Kwang
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Surgery, Seoul National University Hospital, Seoul, Korea.
J Surg Oncol. 2017 Dec;116(7):884-893. doi: 10.1002/jso.24737. Epub 2017 Jun 26.
Surgery for remnant gastric cancer (RGC) frequently fails to obtain the >15 lymph nodes necessary for tumor-node-metastasis (TNM) staging. We aimed to evaluate the utility of the recently developed tumor-ratio-metastasis (TRM) staging system. We also examined the pattern of lymph node metastasis and the role of prophylactic splenectomy in RGC.
Between May 2003 and December 2012, data from 170 patients who underwent surgery for RGC were retrospectively analyzed.
RGC arising after previous benign disease (n = 46) was associated with retrieval of more lymph nodes (27.3 vs 10.0; P < 0.001), and a lower rate of retrieving ≤15 lymph nodes (15.6% vs 77.4%, P < 0.001), than after previous malignant disease (n = 122). The 5 year survival rate according to TNM staging was 75% in stage I, 77.1% in stage II, and 23.5% in stage III, whereas by TRM staging it was 75%, 81.6%, and 23.2%, respectively. Overall survival was not different between the splenectomy and non-splenectomy groups at each stage (P = 0.751, 0.723, 0.151, and 0.706 for stage I, II, III, and IV, respectively).
The analyses did not identify a survival benefit from prophylactic splenectomy or show an improvement in staging with the TRM system for RGC.
残胃癌（RGC）手术常常无法获取肿瘤-淋巴结-转移（TNM）分期所需的15枚以上淋巴结。我们旨在评估最近开发的肿瘤转移率（TRM）分期系统的实用性。我们还研究了RGC的淋巴结转移模式以及预防性脾切除术的作用。
回顾性分析2003年5月至2012年12月期间170例行RGC手术患者的数据。
既往有良性疾病后发生的RGC（n = 46）与获取更多淋巴结相关（27.3枚对10.0枚；P < 0.001），且获取≤15枚淋巴结的比率低于既往有恶性疾病后发生的RGC（n = 122）（15.6%对77.4%，P < 0.001）。根据TNM分期，I期的5年生存率为75%，II期为77.1%，III期为23.5%，而根据TRM分期分别为75%、81.6%和23.2%。各阶段脾切除术组和非脾切除术组的总生存率无差异（I期、II期、III期和IV期的P值分别为0.751、0.723、0.151和0.706）。
分析未发现预防性脾切除术对生存有益，也未显示TRM系统对RGC分期有改善。
