| Objective To compare and analyze the clinicopathological features and survival prognosis of patients with GSC and recurrent gastric stump cancer during the second operation.Methods The clinicopathological data of patients with GSC and recurrent gastric stump cancer after radical gastrectomy were collected from January 2002 to January 2018 in the General Hospital of Ningxia Medical University.According to the different definition,the patients were divided into two groups: GSC group and recurrent gastric stump cancer group.The pathological features and prognosis of the two groups during the second operation were compared.The related data were analyzed by SPSS22.0.If the measurement data obey normal distribution,it will be expressed by?x ąs.If the homogeneity of variance is satisfied,the test method will be t-test,and the counting data will be expressed by frequency and percentage.The test method will use Pearson chi-square test or Fisher exact probability method,Kaplan-Meier method to draw the prognosis survival curve,and log-rank test method to compare the difference of survival.P < 0.05 indicates that the difference is statistically significant.Results A total of 93 patients were included in the study,including 40 patients with GSC and 53 patients with recurrent gastric stump cancer.Among the 40 patients with GSC,there were 37 males and 3 females,with a male-to-female ratio of 12.3 to 1.0.Among the 53 patients with recurrent gastric stump cancer,there were 44 males and 9 females,with a male-to-female ratio of 4.9 to 1.0.There are more males than females.In terms of operation age,the average age of the first operation was 40 years old in the GSC group and 52 years old in the recurrent gastric stump cancer group.The difference between the two groups was statistically significant(P=0.000).The average age of the second operation was 62 years old in the remnant GSC and 56 years old in the recurrent gastric stump cancer group,and the difference was also statistically significant(P=0.012).In terms of the mode of digestive tract reconstruction in the first operation,in the GSC group,Billroth-? was performed in 7 cases(17.5%),Billroth-? in 31 cases(77.5%),and gastroesophageal anastomosis in 2 cases(5.0%).In the group of recurrent gastric stump cancer,the primary digestive tract reconstruction was Billroth-? in 20 cases(37.7%),Billroth-? in 16 cases(30.2%),gastroesophageal anastomosis in 16 cases(30.2%)and Roux-en-Y anastomosis in 1 case(1.9%).There was significant difference in the mode of digestive tract reconstruction in the first operation between the two groups(P=0.000).In terms of histopathology,the histopathological type of the tumor in the second operation in the GSC group was better than that in the recurrent gastric stump cancer group [well differentiated: 52.5%(21/40)vs 18.9%(10/53),P=0.001].Most of the tumors in the GSC group and the recurrent gastric stump cancer group occurred at the anastomotic site,accounting for 65.0% and 73.6%,respectively.In terms of postoperative survival,the median survival time after the second operation in the GSC group was 29 months,which was longer than that in the recurrent gastric stump cancer group(18 months).The difference was statistically significant(P=0.000).Of the 40 patients with GSC,29(72.5%)underwent radical resection and 11(27.5%)underwent palliative surgery.The median survival time of patients undergoing radical surgery was 30 months,which was longer than that of 16 months after palliative surgery.The difference was statistically significant(P=0.001).Of the 53 patients with recurrent gastric stump cancer,40(75.5%)underwent radical resection and 13(24.5%)underwent palliative surgery.The median survival time of patients undergoing radical surgery was 21 months,which was longer than that of 15 months after palliative surgery.The difference was statistically significant(P=0.001).Conclusion 1.GSC is easy to occur after Billroth-?operation;2.GSC and recurrent gastric stump cancer are both likely to occur at the site of anastomosis;3.The histopathological type and the secondary surgical prognosis of GSC were better than those of recurrent gastric stump cancer;4.For patients with GSC and recurrent gastric stump cancer treated by surgery,increasing the rate of radical resection is helpful to improve the survival time;5.Early detection,diagnosis and treatment are helpful to improve the prognosis of patients with GSC and recurrent gastric stump cancer. |
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