| Aim: At present no concept to define the gastric stump carcinoma at home and abroad.This research mainly uses this concept that gastric stump carcinoma(GSC) is defined as a carcinoma occurring in the gastric remnant at least 5 years after surgery for benign peptic ulcer disease and more than 10 years after gastric cancer radical surgical resection. Despite the fact that conservative medical therapy displaced partial gastrectomy for the treatment of ulcer, the incidence of gastric stump carcinoma is not declining, because of the long latency period.This implies that more cases of gastric stump carcinoma will be encountered in the future. Early diagnosis of GSC might be difficult, because most patients are asymptomatic.So the majority of gastric stump carcinoma patients were diagnosed with the middle-late stage.This article analyzed patients clinical features,treatment and PTNM staging were studied the relationship with survival rates, further clarify the effect of prognosis of gastric stump carcinoma。Methods:This review of a prospectively collected gastric cancer database identified 64 patients with GSC from the first clinical hospital of Dalian Medical University between January 2002 and December 2013. Tumors were staged according to the pathological classification(pTNM) of the 7th Edition of the International Union Against Cancer(UICC).And through the telephone and outpatient follow-up,application SPSS19.0 statistical software record and analyze the patient’s gender, age,the first anastomotic type,etc. The 5-year survival rate was calculated using the Kaplan-Meier method and the log-rank test was used compass the groups.Results:1 、 All patients by gastroscope + biopsy diagnosis of gastric stump cancer, 56patients(87.5%) of men and women in 8 cases(12.5%) and male: female is 7:1, aged between 50 and 87, the average age of 66.7 years, for the first time after the operation to the diagnosis of gastric stump cancer interval between 5 ~45 years.2、The most common clinical manifestations of abdominal pain as the above 40cases(62.5%), the second is abdominal distension 8 cases( 12.5%), nausea 2cases(3.1%), vomiting 3 cases(4.7%), and dark 5 cases(7.8%), hematemesis 1case(1.6%), weight loss 3 cases(4.7%), difficulty swallowing 2 cases(3.1%).3、Lesions occurred in anastomotic 55 cases(85.9%), anastomotic Billroth- Ⅰtype group on the 2 cases(3.6%) of anastomotic, Billroth- Ⅱ type group on the 53cases(96.4%) of anastomotic, anastomotic in proportion of the disease in the comparison between two groups of different ways of operation was statistically significant(P < 0.01), confirmed Billroth-II are more likely to happen at anastomotic GSC.followed by gastric cardia department(9.4%), 6 cases of gastric body in 3 patients(4.7%). Endoscopic performance with irregular ulcer is most common, followed by mucous rugged,uneven rough, mucous membrane, bleeding, etc.Tissue types: poorly differentiated lesion of 26 cases(45.6%), undifferentiated 1 case(1.8%), 4 cases of mucous cell carcinoma(7.0%),signet ring cell carcinoma 3 cases(5.3%),moderatelydifferentiated lesion of 17 cases(29.8%), 6 cases of well differentiated lesion(10.5%).4 、 44 cases underwent radical resection, stump stomach full cut + Roux-en-Y anastomosis, which combined splenectomy in 4 cases, transverse colon resection in 3cases, combined resection of pancreatic body tail in 1 case. 9 cases underwent palliative surgery, 6 of whom underwent palliative residual stomach full cut + Roux –en-Y anastomosis. 3 case underwent jejunal fistula.9 cases of abdominal incision, confirmed the tumor closely contact with adjacent organs, unable to surgical resection, or probing peritoneal metastasis nodule, closed abdomen directly.5、64 patients with gastric stump cancer clinical pathologic staging in phase IV,phase III, phase II and phase I of the 16 cases, 22 cases respectively, 18 cases and 8cases.6、Gastric stump carcinoma survival rates of patients mainly affected by PTNM staging of the tumor and the pattern of surgical treatment,were irrelated with sex, time interval and tumor location. |
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