残胃早期胃癌

Early gastric cancer in the remnant stomach.

作者信息

Takeda J, Toyonaga A, Koufuji K, Kodama I, Aoyagi K, Yano S, Ohta J, Shirozu K

机构信息

Department of Gastroenterology and Surgery, Kurume University School of Medicine, Japan.

出版信息

Hepatogastroenterology. 1998 Sep-Oct;45(23):1907-11.

PMID:9840174

Abstract

BACKGROUND/AIMS: Early gastric cancer in the remnant stomach is rare. Periodical endoscopic examinations are mandatory for patients with partial gastrectomy for a good prognosis. Our goal is to improve the surgical management of gastric cancer in the remnant stomach. We have retrospectively investigated a total of 15 rare cases of early gastric cancer after partial gastrectomy.

METHODOLOGY

From 1976 to 1994, a total of 2,102 cases of gastric cancer were resected in our Department. Among these resected cases, 845 cases were histologically diagnosed as having early gastric cancer of the stomach. Of these, 15 patients had previously undergone a partial gastric resection. The time interval between the initial partial gastrectomy and the second resection of the remnant stomach, was more than 10 years for 8 patients (Group 1) and less than 10 years for 7 patients (Group 2). Here we investigate these rare cases of remnant early gastric cancer.

RESULTS

The incidence of early gastric cancer in the remnant stomach was 1.8% (15/845). The cancer location in the remnant stomach was around the stoma and suture line in 75% of Group 1 and in 28.6% of Group 2. The incidence rate of mucosal cancer (m-cancer) was 87.5% for Group 1, and 14.3% for Group 2. Total gastrectomy was selected for 37.5% of Group 1, and for 100% of Group 2. No lymph node metastasis was discovered in both groups. The postoperative mortality was zero in both groups. One patient from Group 2, later died of liver metastasis 2 years after the second total gastrectomy, while the other 9 patients continued to live for more than 5 years with no gastric cancer recurrence to date.

CONCLUSIONS

The outcome for patients with gastric cancer in the remnant stomach is generally considered poor. However, the outcome of early gastric cancer in the remnant stomach was good without major postoperative complications. Therefore, to improve surgical management of remnant-stump gastric cancer, early diagnosis is most important, using periodic endoscopic follow-up examinations, especially around the stoma. When mucosal cancer around the stoma is diagnosed, subtotal gastrectomy can be selected even in gastrectomized patient for a good prognosis.

摘要

背景/目的：残胃早期胃癌较为罕见。对于接受部分胃切除术的患者，定期进行内镜检查对于良好预后至关重要。我们的目标是改善残胃胃癌的外科治疗。我们回顾性研究了总共15例部分胃切除术后的罕见早期胃癌病例。

方法

1976年至1994年，我们科室共切除2102例胃癌病例。在这些切除病例中，845例经组织学诊断为早期胃癌。其中，15例患者此前接受过部分胃切除术。初次部分胃切除与残胃二次切除之间的时间间隔，8例患者超过10年（第1组），7例患者少于10年（第2组）。在此我们研究这些罕见的残胃早期胃癌病例。

结果

残胃早期胃癌的发生率为1.8%（15/845）。残胃中的癌灶位置，第1组75%位于吻合口和缝线处，第2组为28.6%。第1组黏膜癌（m癌）的发生率为87.5%，第2组为14.3%。第1组37.5%的患者选择了全胃切除术，第2组则为100%。两组均未发现淋巴结转移。两组术后死亡率均为零。第2组的1例患者在第二次全胃切除术后2年死于肝转移，而其他9例患者至今存活超过5年，无胃癌复发。