Retrospective clinical analysis of surgical treatment for gastric stump carcinoma
10.3760/cma.j.issn.0529-5815.2016.03.006
- VernacularTitle:残胃癌外科治疗回顾性临床研究
- Author:
Hongqing XI
1
;
Jianxin CUI
;
Chong HU
;
Liangang MA
;
Bo WEI
;
Lin CHEN
Author Information
1. 解放军总医院普通外科
- Keywords:
Stomach neoplasms;
Gastrectomy;
Prognosis
- From:
Chinese Journal of Surgery
2016;54(3):182-186
- CountryChina
- Language:Chinese
-
Abstract:
Objectives To investigate the clinical feature and surgical procedures of gastric stump carcinoma (GSC) and to identify the prognostic factors which influence survival rate of GSC patients.Methods Clinical data of 167 patients who underwent R0 resection for gastric stump carcinoma at Chinese People's Liberation Army General Hospital between January 1990 and December 2012 was collected.There were 144 male and 23 female cases.The clinicopathological features of GSC patients were compared between those who underwent initial surgery for benign disease (GSC-B group,78 cases) and for gastric cancer (GSC-M group,89 cases).The analysis of therapeutic methods and survival time were also performed.t-test was used to compare the quantitative data between two groups.Pearson x2 test was used to compare the various clinicopathological characteristics between the two groups.Kaplan-Meier method was used to analyze the survival rate.Multivariate survival analysis was based on the Cox proportional hazard model.Results Compared with GSC-M group,the interval time between initial gastrectomy and surgery in GSC-B group was longer ((28.2 ± 10.2) years vs.(10.8 ± 1.0) years,t =15.902,P =0.001).There were 56 patients (71.8％) who received Billroth Ⅰ reconstruction in GSC-B group,and 49 patients (55.1％) who received Billroth Ⅱ reconstruction in GSC-M group,the difference of anastomosis method between the two groups was statistically significant (x2 =25.770,P =0.001).Compared with GSC-M group,the tumor of GSC-B group was usually located at the anastomotic site (x2 =6.975,P =0.031).The overall 1-,3-,and 5-year survival rates of the 167 patients were 87％,60％,and 41％.The 5-year survival rates for TNM stages Ⅰ,Ⅱ,and Ⅲ were 65％,43％,and 22％,respectively (P =0.001).Multivariate analysis showed that small intestinal or esophageal infiltration (HR =1.957,95％ CI:1.096 to 3.494,P =0.023),tumor location (HR =1.618,95％ CI:1.104 to 2.372,P =0.014),and TNM stage (HR =2.307,95％ CI:1.708 to 3.118,P =0.001) have independent effect on survival.The metastasis rates of perigastric lymph nodes,jejunum anastomosis and mesenteric lymph nodes were very high (56.3％ and 65.2％,respectively).Conclusions The GSC appears earlier in patients with gastrectomy for malignant disease than those with benign disease.Appropriate curative resection including residual lymph node dissection is very important to improve the prognosis.Small intestinal or esophageal infiltration,tumor location,and TNM stage have independent effect on survival.
