| Purpose To discuss the clinical characteristics of remnant gastric cancer (RGC).Methods Clinical data of 163 patients with RGC admitted to the department of general surgery of Chinese People's Liberation Army General Hospital from January 2005 to January 2015 were collected and reviewed. A Meta-analysis was conducted to assess the association between high expression of EpCAM and clinicopathological features, progression as well as prognosis of RGC.Results The time duration of all the RGC patients between primary gastrectomy and occurrence of RGC ranged from 9 to 46 years (median 27.5 years). Among 163 patients, 112(68.7%)patients manifested as discomfort in the upper abdominal region,47(28.8%) patients had hematemesis and melena,38(23.3%) had vomitting,17(10.4%) had swallowing difficulty and 12(7.4%) had decreasesd weights. In pathology,127(77.9%) cases were median or low grade adenocarcinoma; 114(69.8%) patients were Borrmann type ? gastric cancer under endoscope; 145(88.9%) patients were TNM ?-? gastric cancer. A total of 106 patients underwent operation, including 75(70.8%) patients of radical resection and 31(29.3%) patients of palliative resection. Patients mainly received Billroth ? anastomosis (77.4%) as digestive tract reconstruction, while 57 cases did not receive surgical operation. The overall 1-,3-, and 5-year survival rates of the patients were 76.1%?43.4%?25.8% espectively. The 1-,3-, and 5-year survival rates of the patients undergoing radical resection were 84.3%?77.4%?67.5% espectively. The median survival time of patients receiving radical resection and those receiving palliative resection were 34.6 months and 16.4 months respectively, whereas patients who did not receive surgical operation died 3-8 months after initial diagnosis. This Meta-analysis shows that the expression level of EpCAM in RGC is higher than that in normal gastric mucosa. (RR=2.16,95%CI:1.54-3.03, P<0.00001). EpCAM-positive cases were significantly associated with tumor size (RR:1.68,95%CI:1.47-1.91, P< 0.00001 fixed-effect), depth of invasion (RR:1.37,95%CI:1.11-1.68, P= 0.003 random-effect), TNM stage (RR:2.02,95%CI:1.35-3.02, P= 0.0007 random-effect), tumor location (RR:0.80,95%CI:0.71-0.91, P= 0.0007 fixed-effect), histologic differentiation (RR:1.23,95%CI:1.13-1.33, P< 0.00001 fixed-effect) and lymph node metastasis (RR:1.89,95%CI:1.28-2.80, P= 0.001 random-effect). However, we did not observe any significant association between the presence of EpCAM with age, gender, distant metastasis and Borrmann type. Additionally, EpCAM expression was not associated with the overall survival rate. The pooled HR of the overall effect was 1.39 (95%CI:0.30-6.48, P= 0.67 random-effect).Conclusions Regular gastroscopy is necessary for patients undergoing gastrectomy for over 10 years; Radical resection is of great importance in the treatment of remnant gastric cancer. Meta-analysis shows that high expression level of EpCAM could act as a poor prognostic factor of RGC. |
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