| BackgroundGastric stump cancer(GSC)is a special type of gastric cancer with low clinical morbidity and surgical resection rate,combined with high organ resection rate and mortality rate.Currently,there is no complete data analysis for such diseases and related research are also not in-depth.Therefore,rurther research on residual gastric cancer is particularly important Until 2017,the latest edition of the "Carcinoma Treatment Protocol"published by the Japan Gastric Cancer Association still uses the definition of "Carcinoma in the remnant stomach" proposed by JGCA in 1998,and there was no limit to the time interval for the first stomach surgery.At present,the exact definition of residual gastric cancer remains to be further supplemented and improved.ObjectivesThe purpose of this study is to retrospectively analyze the incidence,clinicopathological features,treatment methods and prognosis of patients who have undergone residual stomach cancer in Shandong Provincial Hospital from March 1992 to March 2018,and further explore and analyze the clinical features of gastric stump cancer.Data and methodsFrom March 1992 to March 2018,a total of 115 patients of gastric cancer recurred after gastrectomy for benign or malignant diseases were treated in Shandong Provincial Hospital.We included these patients who met the concept of "Carcinoma in the remnant stomach" into this study and systematically reviewed the situation of the first surgery,surgical treatment methods,clinicopathological features,epidemiological characteristics and follow-up data of these patients.ResultsAmong all the 115 patients with gastric stump cancer,including 97 males and 18 females.The male-female ratio was 5.39:1.The average age was 63.9 years,the median age was 63 years,and the range of onset age was between 40 and 92 years old.The time interval between occurrence of GSC after the first gastrectomy was 0.33-54 years,with an average of 15.5 years,of which 55 cases(47.8%)were over 10 years.Among all the 115 patients,the first operation was performed in 38 cases(50%,38/76)with Billroth ? type of reconstruction,and 42 cases(42%,42/100)occurred in the gastrointestinal anastomosis,with the highest proportion;Of the 115 patients with gastric stump cancer,46(43%,46/107)patients underwent surgical resection and the combined organ resection rate of surgical treatment was 26.1%(12/46).Postoperative pathology of 46 surgical patients showed:27 cases of poorly differentiated adenocarcinoma(58.7%,27/46),with the highest proportion;the incidence of postoperative complications was about 21.7%(10/46).The local recurrence rate was 22.2%and all cases of local recurrences were located in the abdominal anastomosis.Of the 46 patients with GSC who underwent surgery,the 1-,3-,and 5-year cumulative survival rates of 34 patients undergoing radical resection were respectively 81.5%,37%,and 3.7%,with a median survival time of 25.5 months.The 1-,3-,and 5-year cumulative survival rates of 12 patients undergoing palliative resection were respectively 27.3%,18.2%,and 0%,with a median survival time of 13 months.There was a significant difference in survival rate between the two surgical procedures(P=0.01).Of the 61 patients who didn't undergo surgical resection,49 patients died within 1-32 months after diagnosis.The average survival time of them was 8.67 months,and the remaining 12 cases were unknown.ConclusionsResidual gastric cancer occurs mostly after the Billroth II type of gastrectomy and is more likely to occur in the gastrointestinal anastomosis.The risk of canceration is greatly increased after 10 years of first gastrectomy.Radical surgery has a very positive effect in the treatment of residual gastric cancer.Whether to achieve R0 resection and the N staging of GSC have an important impact on the prognosis of patients with carcinoma in the remnant stomach.The resection rate of residual gastric cancer and the five-year survival rate after surgery are low,and the key to treatment is early diagnosis.Gastroscopic examination is the most effective means of early detection of residual gastric cancer. |
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