Sangu Prashanth, V Sharath Kumar, Rathinasamy Rajkumar, R Prabhakaran, Chidambaranathan Sugumar, O L Naganath Babu
Surgical Gastroenterology, Madras Medical College, Chennai, IND.
Cureus. 2023 Sep 6;15(9):e44798. doi: 10.7759/cureus.44798. eCollection 2023 Sep.
Background The incidence of gastric stump carcinoma (GSC) is not declining because of the long latency period. The survival rate of treated gastric cancer patients has increased due to early detection and improvements in surgical techniques and chemotherapy. Increased survival rates and improved surveillance following gastric surgery have increased the incidence of GSC. Aim The study aims to investigate the clinicopathological factors affecting the interval between index gastric surgery and the occurrence of GSC, and our experience in the management of GSC is presented. Methods A retrospective review of patients diagnosed with GSC in our institution was completed. Patient characteristics and clinicopathological outcomes were analyzed. Results A total of 28 patients were included in this cohort with 17 (60.71%) males and 11 (39.28%) females. The mean interval from index surgery to the incidence of GSC was 24.42 years for benign etiology and six years for malignant etiology. Index surgeries were truncal vagotomy with 14 gastrojejunostomies (50%) and 14 subtotal gastrectomies (50%). The interval between index surgery and the incidence of GSC is not statistically significant concerning the type of surgery (p: 0.661), pathological TNM (tumor, nodes, metastases) stage (p: 0.520), pathological differentiation (p: 0.828), lymphovascular invasion (p: 0.252), perineural invasion (p: 0.672), and adjuvant therapy (p: -0.655). Survival was significantly higher in those patients who received curative resection in comparison to a palliative procedure (p: 0.041). Conclusion Strict surveillance for at least 10 years after initial gastric surgery is of utmost importance as half of the patients fated to develop GSC will do so within this time. In those patients with early diagnosis, no evidence of metastasis, and good performance status, curative surgery is feasible with acceptable morbidity.
背景 由于潜伏期长，残胃癌（GSC）的发病率并未下降。由于早期发现以及手术技术和化疗的改进，接受治疗的胃癌患者的生存率有所提高。胃癌手术后生存率的提高和监测的改善增加了GSC的发病率。目的 本研究旨在调查影响初次胃癌手术与GSC发生间隔的临床病理因素，并介绍我们在GSC管理方面的经验。方法 对我院诊断为GSC的患者进行回顾性研究。分析患者特征和临床病理结果。结果 本队列共纳入28例患者，其中男性17例（60.71%），女性11例（39.28%）。良性病因患者从初次手术到GSC发病的平均间隔为24.42年，恶性病因患者为6年。初次手术包括14例胃空肠吻合术（50%）和14例胃大部切除术（50%）的迷走神经切断术。初次手术与GSC发病之间的间隔在手术类型（p：0.661）、病理TNM（肿瘤、淋巴结、转移）分期（p：0.520）、病理分化（p：0.828）、淋巴管侵犯（p：0.252）、神经周围侵犯（p：0.672）和辅助治疗（p：-0.655）方面无统计学意义。与姑息性手术相比，接受根治性切除的患者生存率显著更高（p：0.041）。结论 初次胃癌手术后至少10年的严格监测至关重要，因为注定会发生GSC的患者中有一半会在此期间发病。对于那些早期诊断、无转移证据且身体状况良好的患者，根治性手术是可行的，发病率可接受。
