对残胃癌临床病理与预后的几点认识

Clinicopathology and prognosis of gastric stump carcinoma

残胃癌是指胃大部切除术后,残胃黏膜在非生理环境下新生的癌。由于鉴别残胃癌与胃癌术后的残胃复发还较为困难,所以在定义上仍存在争议。残胃癌恶性程度偏高,解剖结构的改变使癌浸润出浆膜后易直接浸润粘连在其周围的脏器(T4胃癌),还使淋巴结转移途径易出现左侧或纵隔。T4胃癌的增加也使残胃癌的淋巴结转移范围更广泛。因此,进展程度对残胃癌预后的影响较大,早期残胃癌的预后与一般胃癌类似,而进展期残胃癌则因T4胃癌多,淋巴结转移范围广等特点使手术难以达到R0切除的目的,预后较差。

Carcinomas in the gastric stump occurring after surgery for malignant disease are difficult to be differentiated from tumor recurrence, thus it remains controversial whether to define them as GSC. GSC is prone to invade surrounding organs and has left upper quadrant abdominal and mediastinal lymph nodes metastasis because of altered anatomy. The predominant factor of its prognosis is tumor stage. Early GSC has a similar prognosis as primary gastric cancer of same stage. However, prognosis of advanced GSC stage is much poorer, because complete resection of the tumor combined with radical lymph node dissection is difficult to perform for its surrounding organ invasion and extended lymph nodes metastasis.