Isozaki H, Tanaka N, Fujii K, Nomura E, Tanigawa N
First Department of Surgery, Okayama University Medical School, Japan.
Hepatogastroenterology. 1998 Sep-Oct;45(23):1896-900.
BACKGROUND/AIMS: Carcinoma of the gastric remnant has increased in recent years, but a therapeutic strategy for this disease has not been established. This retrospective study was performed to determine the most appropriate surgical procedure for carcinoma of the gastric remnant.
A total of 25 patients who underwent operation for advanced carcinoma of the gastric remnant that had developed after distal gastrectomy (13 for benign gastric diseases, B group; 12 for gastric carcinoma, M group) were studied. Clinicopathological features, as well as the status of lymph node metastasis, were investigated in the B and M groups.
There were more patients with carcinoma invading other organs, stage IV disease, and with N2 or more lymph node metastasis (especially, with a high metastatic rate to lymph nodes along the splenic artery) in the M group than in the B group. Forty percent of patients in the M group were treated by left upper abdominal evisceration (LUAE), but only 8% in the B group. The survival rate (5-year, 46.0%) of the B group was significantly higher than that (5-year, 11.9%) of the M group. When we compared the survival rate of carcinoma of the gastric remnant with that of primary carcinoma of the upper third of the stomach, there was no difference between the two groups in the curative resection cases.
Almost the same surgical strategy can be adopted for the B group as for primary gastric carcinoma. On the other hand, for the M group, a radical surgical procedure, LUAE, should be recommended.
背景/目的：近年来，残胃癌的发病率有所上升，但针对该疾病的治疗策略尚未确立。本回顾性研究旨在确定残胃癌最合适的手术方式。
对25例行手术治疗的残胃癌患者进行研究，这些患者均为远端胃切除术后发生的进展期残胃癌（良性胃病患者13例，B组；胃癌患者12例，M组）。对B组和M组的临床病理特征以及淋巴结转移情况进行了调查。
M组中侵犯其他器官、处于IV期、伴有N2及以上淋巴结转移（尤其是脾动脉旁淋巴结转移率高）的患者比B组更多。M组40%的患者接受了左上腹脏器清除术（LUAE），而B组仅为8%。B组的生存率（5年生存率为46.0%）显著高于M组（5年生存率为11.9%）。当我们比较残胃癌与胃上部三分之一原发性癌的生存率时，两组在根治性切除病例中无差异。
B组可采用与原发性胃癌几乎相同的手术策略。另一方面，对于M组，应推荐行根治性手术，即LUAE。
