Analysis Of Risk Factors And Clinical Characteristics Of Remnant Gastric Cancer

Objective To exploring the risk factors and clinical features of gastric stump cancer by analysing the hospital medical records information of gastric stump cancer patients.Methods We collected the clinical data of 125 patients who underwent distal gastrectomy and were admitted to Qingdao Municipal Hospital during January 1,2006 to December31,2016 and analysed these materials retrospectively.According to the causes of the first surgery procedure and the current diagnosis,all the patients were divided into four groups:primary gastric stump cancer group,gastric stump benign disease group,recurrent gastric stump cancer group,nonrecurrent gastric stump cancer group.Each group was grouped further according to these factors which may infect the occurrence of gastric stump cancer,such as gender,age of first surgery,type of the first surgery,reflux and Helicobacter Pylori infection.Using Chi-square test analysed the correlation between those risk factors and gastric stump cancer,type of the first surgery and reflux,type of the first surgery and HP infection,reflux and HP infection.Also we compared the cancer primary sites and degree of differentiation of primary gastric stump cancer group and recurrent gastric stump cancer group in the same way.We analysed multiple factors above mentioned with Logistic regression analysis,with P < 0.05 on behalf of the difference is statistically significant.Results 1.Of the 62 patients with gastric stump cancer,40(64.5%)were mainly attending to upper abdominal pain,abdominal distention,nausea,vomiting,fatigue,7(11.3%)were dysphagia,and 9(14.5%)were melena,6(9.7%)cases without special discomfort.2.The interval from the first surgery to diagnosing as gastric stump cancer:for primary gastric stump cancer patients is 9 ~ 50 years,averaging 36.3 years.For recurrent gastric stump cancer the median is 7 years(5 ~ 31years).3.The differences in gender,type of the first surgery,the diseases for which the first surgery was conducted and reflux between primary gastric stump cancer group and its control group were statistically significant(P < 0.05).But,the differences in HP infection and the initial surgery age < 40 years old had no statistical significance(P > 0.05).4.The differences were statistically significant(P < 0.05)in gender and reflux between recurrent gastric stump cancer group and its control group(nonrecurrent gastric stump cancer group).However,type of the first surgery,HP infection and the initial surgery age < 40 in recurrent gastric stump cancer group weren't statistically significant(P > 0.05)compared with its control group.5.The difference in the degree of tumor differentiation between primary gastric stump cancer group and recurrent gastric stump cancer group was statistically significant(c2=4.719,P < 0.05).6.The difference in the tumor location of primary gastric stump cancer group and recurrent gastric stump cancer group was statistically significant(c2=4.084,P < 0.05).Conclusion 1.The gastric stump cancer patients' clinical manifestations mainly include the nonspecific symptoms.Patients with remnant gastric without special discomfort should also be regularly reviewed.2.The interval from first surgery to confirming as gastric stump cancer for primary gastric stump cancer patients is 36.3 years,longer than that of recurrent gastric stump cancer patients(7 years).The tumor location of primary gastric stump cancer usually is at anastomotic,while the recurrent gastric stump cancer occurs at the other part of remnant gastric.3.The degree of differentiation of primary gastric stump cancer is higher than recurrent gastric stump cancer.4.The risk factors of primary gastric stump cancer include male,the first surgery for gastric ulcer and its complications,the first surgery with Billroth ?,reflux positive.The top three are the independent risk factors of primary gastric stump cancer.HP Positive infection and the first operation age <40 years have no effect on the occurrence of primary gastric stump cancer.Male,reflux positive are the independent risk factors of recurrent gastric stump cancer.HP infection positive,first operation Age <40 years have no effect on the occurrence of recurrent gastric stump cancer.