Study Of Extension And Resection Length Of Gastric Cancer With Giant Sections

Object: to investigate the infiltration of the duodenum, and proper resection length of duodenum with different length from gastric cancer border to the pylorus in various infiltration conditions of gastric cancer.Method: 146 patients with gastric cancer who underwent resection at Qilu hospital of Shandong University between July 2006 and April 2007 were collected. The duodenal change in length during gastrectomy operation in 7 patients was measured. After fixation, the distance from pylorus to the tumour border was measured. A longitudinal stripe was sliced along the center from removed specimen, which contained the tumor, pylorus and duodenum, then the length and scope of the maximal diameter of gastric cancer were measured. It was placed into 10% formalin solution and made into a giant section at last, which was observed by microscope. According to the principle of the length changing uniformity in the same duodenal wall, The true infiltration length in duodenum can be calculated, the impact factor of which can be analysed by logistic regression.Result: The infiltration in duodenal wall, gastric epithelial dysplasia, vascular invasion, lymphatic invasion, positive resection margins, etc,can be observed. It was no difference between the distance measured without pulling and that away from body, but they were different from which after pulling. The infiltration for localized type gastric cancer included Borrmann I type and BorrmannII type tumor, was not found, but for infiltrative type gastric cancer included BorrmannIII type and BorrmannIV type tumor, was found. There is 4 cases of bulge type found infiltration and 23 cases of Infiltration type. the distance from the pylorus to the tumour border, macroscopic type and Ming typeare three stable independent impact factor in infiltration of duodenal wall of gastric cancer by logistic regression analysis. The distance from pylorus to the tumour border is an impact factor of infiltration distance in duodena wall of gastric cancer by logistic regression analysis.Conclusion: The resection length of duodenum for early gastric cancer(abroad type is not included) and localized type gastric cancer include Borrmann I type and Borrmann II type tumor only to in sure the pylorus is completely resected. But you should make sure the real location of the pylorus when fibrose hyperplasia is found. For BorrmannIII type tumor if the distance from pylorus to the tumour border is more than 2cm and belongs to bulge type only to make sure the pylorus is completely resected; and if belongs to Infiltration type we should resect 2cm of duodenum; but if explore not clearly just go for rapid pathology. For BorrmannIV type tumor if the distance from pylorus to the tumour border is more than 2cm, we should resect 2cm to 3 cm of duodenum; if the distance from pylorus to the tumour border is less than 2cm, we must go for rapid pathology. But the resection length should be decided in a normal status without pulling.