49例胃癌根治术后残胃复发的外科治疗和预后分析

Recurrent Adenocarcinoma within the Gastric Remnant after Curative Surgery:Surgical Treatment and Survival Analysis of 49Patients

目的:探讨胃癌根治术后残胃复发癌的可切除性和预后影响因素。方法:对1986～2002年间在我院接受手术治疗的胃癌根治术后残胃复发的49例患者进行回顾性研究。结果:本组病例的根治性切除率为36.7%(18/49)。合并腹膜复发者无1例获得根治性切除。非吻合口处残胃复发的根治切除率为45.5%(10/22),吻合口处残胃复发者为29.6%(8/27)。获得根治切除患者的5年生存率为26.7%,未获得根治切除者为0。未合并腹膜复发患者的5年生存率为15.6%,合并腹膜复发者为0。结论:残胃复发癌不能被根治切除的主要原因是同时合并腹膜复发,或肿瘤复发侵犯周围重要脏器,吻合口处的复发肿瘤的根治性切除率有减低的趋势。复发肿瘤能否被根治切除、是否合并腹膜复发直接影响患者的预后。

Objective:To study the curative resectability of the recurrent cancer within the gastric remnant and factors influ encing survival.Methods:Database of patients with recurrent gastric cancer,who underwent surgical treatment at Cancer Hospital of CAMS &PUMC between1986and2002were reviewed.Results:The resection rate of recurrent tumors was36.7%(18/49)in this series.None of the patients with a concomitant peritoneal carcinomatosis underwent cura tive resection.The resection rates of patients with non-anastomostic and anatomostic recur -rence within the gastric remnant was45.5%(10/22)and29.6%(8/27)respec tively.The5-year survival rate of resected patients was26.7%,however the rate was0for the non-resected.Pa-tients with a con comitant peritoneal carcinomatosis had a5-year survival rate of was o,while those without had a rate of15.6%.Conclusion:Con comitant peritoneal carcinomatosis or invasion to adjacent vital structures prevents the recurrent cancer within the gastric remnant from curative resection,and compared with non-anastomostic recurrence,anastomostic recurrence tends to have a lower resection rate.The resectability and concomitant peritoneal carcinomatosis directly influ-ence survival.