Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
World J Surg Oncol. 2020 Feb 27;18(1):43. doi: 10.1186/s12957-020-01821-y.
Total gastrectomy (TG) is a widely accepted procedure for treating gastric stump cancer (GSC). However, subtotal gastrectomy (SG) would benefit elective patients with GSC. The aim of this study was to clarify the safety and long-term prognosis of SG in treating GSC after distal gastrectomy for benign lesions.
A total of 53 patients with GSC located at the anastomotic site or gastric body between May 1999 and December 2018 at our hospital were included. In total, 21 patients underwent SG, and the remaining 24 patients underwent TG. Clinicopathological data, operative data, and overall survival (OS) were compared.
The operative duration, estimated blood loss volume, and length of hospital stay were similar between the SG and TG groups. The postoperative complications were similar between the two groups, but no cases of anastomotic leakage were noted in the SG group. TG was associated with significantly more retrieved lymph nodes than SG (18.5 ± 11.5 vs. 10.7 ± 9.2; p = 0.017), while the number of metastatic lymph nodes did not differ between the groups (2.9 ± 3.5 vs. 1.9 ± 3.6; p = 0.329). The median survival time in the SG group was 81.0 months (95% confidence interval (CI), 68.906 to 93.094 months), which was similar to the 45.0 months (95% CI, 15.920 to 74.080 months) observed in the TG group (p = 0.236). Both univariate and multivariate analyses showed that tumor location and histological type were prognostic factors, while surgery type was not a prognostic factor. Further stratified analyses according to tumor location revealed that OS was not significantly different between the two groups among patients with tumors located at the anastomotic site, while OS in the TG group was significantly better than that in the SG group among patients with tumors located in the gastric body (p = 0.046).
The results of the current study indicate that SG is a suitable alternative surgical procedure for GSC located at the anastomotic site after distal gastrectomy for benign lesions. The short-term outcomes and long-term prognoses of SG are comparable with those of TG.
全胃切除术（TG）是治疗残胃癌（GSC）的广泛接受的方法。然而，对于 GSC 的择期患者，次全胃切除术（SG）可能更有益。本研究旨在阐明在因良性病变行远端胃切除术后治疗 GSC 时，SG 的安全性和长期预后。
本研究共纳入 53 例位于吻合口或胃体的 GSC 患者，这些患者均于 1999 年 5 月至 2018 年 12 月在我院接受治疗。其中，21 例行 SG，24 例行 TG。比较两组的临床病理数据、手术数据和总生存期（OS）。
SG 组和 TG 组的手术时间、估计失血量和住院时间相似。两组术后并发症相似，但 SG 组无吻合口漏发生。TG 组的淋巴结检出数明显多于 SG 组（18.5±11.5 vs. 10.7±9.2；p=0.017），但两组的转移淋巴结数无差异（2.9±3.5 vs. 1.9±3.6；p=0.329）。SG 组的中位生存时间为 81.0 个月（95%置信区间（CI）：68.906 至 93.094 个月），与 TG 组的 45.0 个月（95%CI：15.920 至 74.080 个月）相似（p=0.236）。单因素和多因素分析均显示，肿瘤位置和组织学类型是预后因素，而手术类型不是预后因素。根据肿瘤位置进一步分层分析显示，在吻合口部位肿瘤患者中，两组间 OS 无显著差异，而在胃体部位肿瘤患者中，TG 组的 OS 明显优于 SG 组（p=0.046）。
本研究结果表明，对于因良性病变行远端胃切除术后位于吻合口的 GSC，SG 是一种合适的替代手术方法。SG 的短期结果和长期预后与 TG 相当。
