Furukawa H, Iwanaga T, Hiratsuka M, Imaoka S, Ishikawa O, Kabuto T, Sasaki Y, Kameyama M
Department of Surgery, Centre for Adult Diseases, Osaka, Japan.
Br J Surg. 1993 Jan;80(1):54-6. doi: 10.1002/bjs.1800800120.
The pathological characteristics and natural history of 35 gastric remnant cancers after partial gastrectomy for a malignant condition and 16 gastric cancers after gastrectomy for benign conditions were compared. Gastric remnant cancer following malignant disease was characterized by a well defined rather than diffuse appearance (in 43 versus 12 per cent of gastric remnant cancers after benign conditions, P < 0.05), location away from the anastomosis (83 versus 25 per cent, P < 0.05) and a shorter interval after the first operation (5-14 versus > or = 20 years, P < 0.01). The 15- and 16-year survival rates appeared to be worse for gastric remnant cancer after malignant than after benign disease, but there was no statistically significant difference between the two groups in a generalized Wilcoxon test. In the former, direct invasion to adjacent organs was frequently observed. These findings suggest that gastric remnant cancer after gastrectomy for malignancy may be a metachronous multiple lesion, while that following benign disease may occur as a new cancer caused by the partial gastrectomy. To improve the survival of patients with cancer after gastrectomy for malignancy, a rational extended operation may be useful.
比较了35例因恶性疾病行胃部分切除术后发生的残胃癌和16例因良性疾病行胃切除术后发生的胃癌的病理特征及自然病程。恶性疾病后的残胃癌表现为边界清晰而非弥漫性（良性疾病后残胃癌中分别为43%和12%，P<0.05），远离吻合口（83%和25%，P<0.05），首次手术后间隔时间较短（5 - 14年与≥20年，P<0.01）。恶性疾病后的残胃癌15年和16年生存率似乎比良性疾病后的残胃癌更差，但在广义Wilcoxon检验中两组间无统计学显著差异。在前者中，常观察到直接侵犯相邻器官。这些发现提示，因恶性疾病行胃切除术后的残胃癌可能是异时性多病灶，而良性疾病后的残胃癌可能是由胃部分切除术导致的新发癌症。为提高因恶性疾病行胃切除术后癌症患者的生存率，合理的扩大手术可能有用。
