Department of Internal medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
Department of Internal medicine, Seoul Medical Center, Seoul, Republic of Korea.
PLoS One. 2018 Jun 1;13(6):e0196170. doi: 10.1371/journal.pone.0196170. eCollection 2018.
There have been only a few reports investigating the clinical efficacy of follow-up endoscopy for detection of recurrent gastric cancer after total gastrectomy (TG). We reviewed the records of 747 patients undergoing TG from 2003 to 2012 and enrolled 267 patients (70 with early gastric cancer (EGC) and 197 with advanced gastric cancer (AGC)), who received one or more follow-up endoscopy and contrast abdominal computed tomography (CT) scan. We found no tumor recurrence in the 70 EGC patients during the mean follow-up periods of 42.1 ± 18 and 43.2 ± 19 months by endoscopy and contrast abdominal CT scan. In 197 AGC patients, 59 patients (29.8%) had confirmed tumor recurrence during mean follow-up periods of 40.5 ± 21 and 45.3 ± 22 months. The most common pattern of tumor recurrence was distant metastasis (n = 35) followed by peritoneal metastasis (n = 11). Among the other 13 cases with loco-regional recurrence, seven cases were regional lymph node metastases, four were anastomosis site recurrences, and two were duodenal stump and jejunal loop site recurrences. Three of the four cases of anastomosis site recurrence were found by both endoscopy and contrast abdominal CT scan; one case was missed by contrast abdominal CT scan. However, the two cases with duodenal stump and jejunal loop recurrences were detected by contrast abdominal CT scan only. An annual follow-up endoscopy for gastric cancer after TG might have a limited role in the detection of tumor recurrence, especially in patients with EGC. Contrast abdominal CT scan may be sufficient as a follow-up method for recurrent gastric cancer after TG.
仅有少数报道研究了全胃切除术后（TG）随访内镜检查对复发性胃癌的临床疗效。我们回顾了 2003 年至 2012 年间接受 TG 的 747 例患者的记录，并纳入了 267 例患者（70 例早期胃癌（EGC）和 197 例进展期胃癌（AGC）），他们接受了一次或多次随访内镜检查和对比腹部 CT 扫描。我们发现，在平均 42.1 ± 18 个月和 43.2 ± 19 个月的内镜和对比腹部 CT 扫描随访期间，70 例 EGC 患者中未发现肿瘤复发。在 197 例 AGC 患者中，59 例（29.8%）在平均 40.5 ± 21 个月和 45.3 ± 22 个月的随访期间确认肿瘤复发。肿瘤复发最常见的模式是远处转移（n = 35），其次是腹膜转移（n = 11）。在其他 13 例局部复发的病例中，7 例为区域淋巴结转移，4 例为吻合口复发，2 例为十二指肠残端和空肠袢复发。吻合口复发的 4 例中有 3 例在内镜和对比腹部 CT 扫描中均发现，1 例在对比腹部 CT 扫描中漏诊。然而，仅在对比腹部 CT 扫描中发现了十二指肠残端和空肠袢的 2 例复发。每年对 TG 后胃癌进行一次随访内镜检查可能对肿瘤复发的检测作用有限，尤其是在 EGC 患者中。对比腹部 CT 扫描可能足以作为 TG 后复发性胃癌的随访方法。
