Appraisal of gastric stump carcinoma and current state of affairs

Gastric stump carcinoma,also known as remnant gastric carcinoma,is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition.Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma.The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases.The tumor location is predominantly at the anastomotic site towards the stomach.However,it can occur anywhere in the remnant stomach.The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer.Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome.However,recent advances in diagnostic and therapeutic strategies have improved outcomes.Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes,thereby providing novel therapeutic targets.Also,reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis,staging,and treatment of these tumors.The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.

Does gastric stump cancer really differ from primary proximal gastric cancer? A multicentre, propensity score matching-used, retrospective cohort study

BACKGROUND Although the location of proximal cancer of the remnant stomach is the same as that of primary proximal cancer of the stomach,its clinical characteristics and prognosis are still controversial.AIM To evaluate the clinicopathological features and prognosis factors of gastric stump cancer(GSC)and primary proximal gastric cancer(PGC).METHODS From January,2005 to December,2016,178 patients with GSC and 957 cases with PGC who received surgical treatment were enrolled.Patients in both groups underwent 1:1 propensity score matching analysis,and both clinical and pathological data were systematically collected for statistical purposes.Quality of RESULTS One hundred and fifty-two pairs were successfully matched after propensity score matching analysis.Of the 15 demographic and pathological variables collected,the analysis further revealed that the number of lymph nodes and positive lymph nodes were different prognostic and clinicopathological factors between PGC and GSC.Univariate and multivariate analyses showed that gender,differentiation degree and tumor-node-metastasis stage were independent risk factors for patients with GSC.Gender,vascular invasion,differentiation degree,depth of infiltration,positive lymph nodes,and tumor-node-metastasis stage were independent risk factors for patients with PGC.The 5-year overall survival and cancer-specific survival of patients with GSC were significantly lower than those in the PGC group,the scores for overall quality of life in the GSC-malignant group were lower than the GSC-benign,and the differences were statistically significant.CONCLUSION The differences in clinicopathological characteristics between GSC and PGC were clarified,and PGC had a better prognosis than GSC.

The Early Diagnosis and Surgical Treatment of the Gastric Stump Carcinoma

The clinical data of 30 patients with GSC after partial gastrectomy for benign gastric dis- eases were analyzed retrospectively. Eleven cases accepted radical resection, 11 cases palliative resec- tion and the remaining 8 underwent exploratory laparotomy. It was emphasized that the detection of stump cancer at a relatively early stage, mainly due to screening programmes for gastrectomised pa- tients, was important in improving its prognosis.

Mixed neuroendocrine carcinoma of the gastric stump: A case report

BACKGROUND Gastric stump cancer,also known as gastric remnant cancer(GRC),is one of the main complications of postgastrectomy syndrome,which usually occurs following Billroth II reconstruction.The predominant histological subtype of GRC is adenocarcinoma,whereas neuroendocrine carcinoma is relatively rare.In particular,there are few recently reported cases of mixed neuroendocrine carcinoma(MNEC)in the English literature.Here,we present an extremely rare case of MNEC of the gastric stump.CASE SUMMARY A 59-year-old patient presented to our department owing to chronic constipation.He had undergone subtotal gastric resection 35 years prior to admission because of benign peptic ulcer.After admission,the patient underwent several tests,and gastroendoscopy showed evidence of Billroth II gastrectomy and local thickening of the gastric stump mucosa at the gastrojejunostomy site,with bile reflux;pathological biopsy revealed adenocarcinoma.He was then diagnosed with GRC and underwent total gastrectomy,D2 Lymphadenectomy,and esophagojejunal Roux-en-Y reconstruction.Histopathological examination of the specimen identified MNEC comprising MNEC(60%),adenocarcinoma(30%),and squamous cell carcinoma(10%).Postoperative adjuvant chemotherapy was initiated on September 17,2020.Taxol plus cisplatin was administered for only one cycle because of severe liver function damage,and the regimen was changed to etoposide plus cisplatin on October 10,2020 for five cycles.The patient recovered,with no recurrence after 6 mo of follow-up.CONCLUSION Gastric MNECs(GMNECs)is a rare type of GRC.This study presented the unusual occurrence of GMNEC in the gastric stump.This case will contribute to improvements in our understanding of the carcinogenesis,biology,pathology,and behavior of GMNEC and GRC.

Prognostic factors and survival in patients with gastric stump cancer

AIM:To elucidate the clinicopathological characteristics and prognostic factors of gastric stump cancer(GSC).METHODS:The clinical data for 92 patients with GSC were collected at Fudan University Shanghai Cancer Center.The prognostic factors were analyzed with Cox proportional hazard models.RESULTS:GSC tended to occur within 25 years following the primary surgery,when the initial disease is benign,whereas it primarily occurred within the first15 years post-operation for gastric cancer.Patients with regular follow-up after primary surgery had a better survival rate.The multivariate Cox regression analysis revealed that Borrmann type?Ⅰ/Ⅱ(HR=3.165,95%CI:1.055-9.500,P=0.040)and radical resection(HR=1.780,95%CI:1.061-2.987,P=0.029)were independent prognostic factors for GSC.The overall 1-,3-,and 5-year survival rates of the 92 patients were78.3%,45.6%and 27.6%,respectively.The 1-,3-,and 5-year survival rates of those undergoing radical resection were 79.3%,52.2%,and 37.8%,respectively.The 5-year survival rates for stages?Ⅰ,Ⅱ,Ⅲ,andⅣwere 85.7%,47.4%,16.0%,and 13.3%,respectively(P=0.005).CONCLUSION:The appearance of GSC occurs sooner in patients with primary malignant cancer than in patients with a primary benign disease.Therefore,close follow-up is necessary.The overall survival of patients with GSC is poor,and curative resection can improve their prognosis.

Surgical management of gastric stump cancer:a report of 37 cases

Objective: To observe the clinicopathological characteristics of gastric stump cancer (GSC) and evaluate the benefits of radical surgery of GSC. Methods: The clinicopathological characteristics and postoperative survival time of 37 GSC patients who underwent surgery were investigated retrospectively. The survival time was compared according to the type of surgical pTMN stage. Survival curves were traced by using Kaplan-Meier methods. Results: Most GSC (32/37) was detected in patients who had received Billroth Ⅱ reconstruction after partial gastrectomy for benign gastric disease. The lesser curvature side and the suture line of anastomosis were the most frequent sites where GSC occurred (27/37). Differentiated adenocarcinoma was the dominant histopathological type (24/37). The postoperative 5-year survival rate of early stage GSC patients (n=9) was significantly higher than advanced stage GSC (n=12) (55.6% vs 16.5%, xL2=1 1.48, P＜0.01). Five-year survival rate of 21 GSC patients with radical resection were 75% (3/4) for stage Ⅰ, 60% (3/5) for stage Ⅱ, 14.2% (1/7) for stage Ⅲ, and 0% (0/5) for stage Ⅳ respectively.The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative operation (43.0m vs 13.0m, xL2=36.31, P＜0.01), the median survival time of stage Ⅳ patients with radical resection was 23.8months. Conclusions: Without remote metastasis, radical resection for GSC is possible, and is an effective way to improve the prognosis of GSC. Even in stage Ⅳ GSC, radical resection can still prolong the survival time. It is necessary for the patients with benign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up, especially in patients with Billroth Ⅱ reconstruction procedure at 15-20 years.

Surgical resection of gastric stump cancer following proximal gastrectomy for adenocarcinoma of the esophagogastric junction

BACKGROUND Proximal gastrectomy(PG) is performed widely as a function-preserving operation for early gastric cancer located in the upper third of the stomach and is an important function-preserving approach for esophagogastric junction(EGJ)adenocarcinoma. The incidence of gastric stump cancer(GSC) after PG is increasing. However, little is known about the GSC following PG because very few studies have been conducted on the disease.AIM To clarify clinicopathologic features, perioperative complications, and long-term survival rates after the resection of GSC following PG.METHODS Data for patients with GSC following PG for adenocarcinoma of the EGJ diagnosed between January 1998 and December 2016 were retrospectively reviewed. Multivariate analysis was performed to identify factors associated with overall survival(OS). GSC was defined in accordance with the Japanese Gastric Cancer Association.RESULTS A total of 35 patients were identified. The median interval between the initial PGand resection of GSC was 4.9(range 0.7-12) years. In 21 of the 35 patients, the tumor was located in a nonanastomotic site of the gastric stump. Total gastrectomy was performed in 27 patients; the other 8 underwent partial gastrectomy. Postoperative complications occurred in 6 patients(17.1%). The tumor stage according to the depth of tumor invasion was T1 in 6 patients, T2 in3 patients, T3 in 9 patients, and T4 in 17 patients. Lymph node metastasis was observed in 18 patients. Calculated 1-, 3-, and 5-year OS rates were 86.5%, 62.3%,and 54.2%, respectively. Multivariate analysis showed advanced T stage to be associated with OS.CONCLUSION This study reveals the characteristics of GSC following PG for adenocarcinoma of the EGJ and suggests that a surgical approach can lead to a satisfactory outcome.

Neuroendocrine carcinoma of the gastric stump:A case report and literature review

We herein report a case of neuroendocrine carcinoma of the gastric stump found 47 years after Billroth II gastric resection for a benign gastric ulcer. A 74-yearold man was referred to another hospital with melena. Endoscopic examination revealed a localized ulcerative lesion at the gastrojejunal anastomosis. The diagnosis by endoscopic biopsy was neuroendocrine carcinoma. A total gastrectomy of the remnant stomach with D2 lymphadenectomy was performed at our hospital. The lesion invaded the subserosa, and metastasis was found in two of nine the lymph nodes retrieved. The lesion was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 60%. The diagnosis of neuroendocrine carcinoma of the gastric stump was confirmed using World Health Organization 2010 criteria. Subsequently, the patient underwent one course of adjuvant chemotherapy with the etoposide plus cisplatin(EP) regimen; however, treatment was discontinued due to grade 3 myelosuppression. The patient showed lymph node metastasis in the region around the gastrojejunal anastomosis in the abdominal cavity 7 mo post-surgery. He then underwent radiotherapy and platinum-based combination chemotherapy; however, the disease progressed and liver recurrence was observed on follow-up computedtomography at 16 mo post-surgery. The patient then received chemotherapy with regimens used for the treatment of small cell lung cancer in first-and secondline settings. The patient died of disease progression 31 months after surgery.

Management of duodenal stump fistula after gastrectomy for gastric cancer: Systematic review

AIM: To identify the most effective treatment of duodenalstump fistula(DSF) after gastrectomy for gastric cancer.METHODS: A systematic review of the literature was performed. Pub Med, EMBASE, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and Up To Date databases were analyzed. Three hundred eighty-eight manuscripts were retrieved and analyzed and thirteen studies published between 1988 and 2014 were finally selected according to the inclusion criteria, for a total of 145 cases of DSF, which represented our group of study. Only patients with DSF after gastrectomy for malignancy were selected. Data about patients' characteristics, type of treatment, short and long-term outcomes were extracted and analyzed. RESULTS: In the 13 studies different types of treatment were proposed: conservative approach, surgical approach, percutaneous approach and endoscopic approach(3 cases). The overall mortality rate was 11.7% for the entire cohort. The more frequent complications were sepsis, abscesses, peritonitis, bleeding, pneumonia and multi-organ failure. Conservative approach was performed in 6 studies for a total of 79 patients, in patients with stable general condition, often associated with percutaneous approach. A complete resolution of the leakage was achieved in 92.3% of these patients, with a healing time ranging from 17 to 71 d. Surgical approach included duodenostomy, duodenojejunostomy, pancreatoduodenectomy and the use of rectus muscle flap. In-hospital stay of patients who underwent relaparotomy ranged from 1 to 1035 d. The percutaneous approach included drainage of abscesses or duodenostomy(32 cases) and percutaneous biliary diversion(13 cases). The median healing time in this group was 43 d. CONCLUSION: Conservative approach is the treatment of choice, eventually associated with percutaneus drainage. Surgical approach should be reserved for severe cases or when conservative approaches fail.

Computer simulation of flow and mixing at the duodenal stump after gastric resection

AIM:To investigate the flow and mixing at the duodenal stump after gastric resection, a computer simulation was implemented.METHODS: Using the finite element method, two different Billroth procedure cases(A and B)were modeled.Case A was defined with a shorter and almost straight duodenal section,while case B has a much longer and curved duodenal section.Velocity,pressure and food concentration distribution were determined and the numerical results were compared with experimental observations.RESULTS:The pressure distribution obtained by numerical simulation was in the range of the recorded experimental results.Case A had a more favorable pressure distribution in comparison with case B. However,case B had better performance in terms of food transport because of more continual food distribution, as well as better emptying of the duodenal section.CONCLUSION: This study offers insight into the transport process within the duodenal stump section after surgical intervention, which can be useful for future patient-specific predictions of a surgical outcome.

中国标准下残胃癌的临床病理特征及预后影响因素

目的探讨不同定义下残胃癌的临床病理特征和预后,以及中国标准下残胃癌的预后影响因素。方法采用回顾性队列研究方法。收集中山大学附属第六医院病例数据库中2008年9月至2022年11月期间收治的残胃癌变(残胃上的癌)患者和普通胃癌患者的临床资料。采用倾向性评分匹配(PSM)比较两组患者匹配前后的临床病理特征和预后。将残胃癌变组中符合中国标准(因良性疾病行胃切除术后5年以上或胃癌行胃切除术后10年以上)的定义为A组,不符合的定义为B组,比较两组患者的临床病理特征和预后,并用Cox回归模型分析影响A组患者预后的因素。结果残胃癌变组纳入病例39例,普通胃癌组纳入病例1293例。残胃癌变组男性占比更多,老年占比更多,术前营养状况更差,预后更差,组间差异有统计学意义(P<0.05)。采用PSM后两组间预后的差异仍有统计学意义(P<0.05)。将残胃癌变组按中国标准分组后,A组纳入病例32例,B组纳入病例7例。A组男性占比更多,初次手术为良性疾病占比更多,两组间预后的差异无统计学意义(P>0.05)。Cox回归分析显示,术前CA199升高和pN3期是影响A组患者预后的独立危险因素。结论残胃癌变较普通胃癌的临床病理特征及预后明显较差,在中国标准界定下A组和B组在临床病理特征上有所差别,但两者的生存预后相类似。术前CA199升高和pN3期是A组患者预后的独立危险因素。

Extensive cutaneous metastasis of recurrent gastric cancer:A case report

BACKGROUND Cutaneous metastasis is a rare event associated with poor prognosis for gastric cancer and has been rarely reported in the literature.CASE SUMMARY A 69-year-old male patient who had undergone salvage gastrectomy and a few courses of adjuvant chemotherapy 3 mo earlier for recurrent gastric cancer developed widespread cutaneous metastases.Due to the patient’s intolerance to further adjuvant chemotherapy,he was placed in hospice care and expired 1 mo later.In the literature,gastric cancers are rarely reported as the primary malignancies for cutaneous metastasis.We,thus,provide an update on a case review published in 2014 by reviewing 10 more case reports dated from 2014 to 2020.The average age for the new group of patients was 59.4±18.88-years-old.Thirty percent of the patients presented with cutaneous lesions and advanced gastric cancer synchronously while 70%developed cutaneous metastases 1.3 years to 14 years after the initial treatment for primary gastric cancer.Eighty percent of the patients received either local excision or chemo±radiation therapy to treat their cutaneous metastases.CONCLUSION This report highlights cutaneous metastasis as a late and untreatable metastasis of gastric cancer.

Remnant gastric cancer:An ordinary primary adenocarcinoma or a tumor with its own pattern?

BACKGROUND Remnant gastric cancer(RGC)is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis.However,there little information available regarding RGCs and their prognostic factors and survival.AIM To evaluate the clinicopathological characteristics and prognosis of RGC after previous gastrectomy for benign disease.METHODS Patients who underwent curative resection for primary gastric cancer(GC)at our institute between 2009 and 2019 were retrospectively evaluated.All RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in this study.Primary proximal GC(PGC)who underwent total gastrectomy was selected as the comparison group.Clinical and pathological data were collected from a prospective medical database.RESULTS A total of 41 patients with RGC and 120 PGC were included.Older age(P=0.001),lower body mass index(P=0.006),hemoglobin level(P<0.001),and number of resected lymph nodes resected(LN)(P<0.001)were associated with the RGC group.Lauren type,pathological tumor-node-metastasis,and perioperative morbimortality were similar between RGC and PGC.There was no difference in disease-free survival(P=0.592)and overall survival(P=0.930)between groups.LN status was the only independent factor related to survival.CONCLUSION RGC had similar clinicopathological characteristics to PGC.Despite the lower number of resected LN,RGC had a similar prognosis.

Subtotal gastrectomy for gastric cancer

Although a steady decline in the incidence and mortality rates of gastric carcinoma has been observed in the last century worldwide,the absolute number of new cases/year is increasing because of the aging of the population. So far,surgical resection with curative intent has been the only treatment providing hope for cure;therefore,gastric cancer surgery has become a specialized field in digestive surgery. Gastrectomy with lymph node(LN) dissection for cancer patients remains a challenging procedure which requires skilled,well-trained surgeons who are very familiar with the fast-evolving oncological principles of gastric cancer surgery. As a matter of fact,the extent of gastric resection and LN dissection depends on the size of the disease and gastric cancer surgery has become a patient and "diseasetailored" surgery,ranging from endoscopic resection to laparoscopic assisted gastrectomy and conventional extended multivisceral resections. LN metastases are the most important prognostic factor in patients that undergo curative resection. LN dissection remains the most challenging part of the operation due to the location of LN stations around major retroperitoneal vessels and adjacent organs,which are not routinely included in the resected specimen and need to be preserved in order to avoid dangerous intra-and postoperative complications.Hence,the surgeon is the most important non-TMN prognostic factor in gastric cancer.Subtotal gastrectomy is the treatment of choice for middle and distal-third gastric cancer as it provides similar survival rates and better functional outcome compared to total gastrectomy,especially in early-stage disease with favorable prognosis.Nonetheless,the resection range for middle-third gastric cancer cases and the extent of LN dissection at early stages remains controversial.Due to the necessity of a more extended procedure at advanced stages and the trend for more conservative treatments in early gastric cancer,the indication for conventional subtotal gastrectomy depends on multiple variables.This review aims to clarify and define the actual landmarks of this procedure and the role it plays compared to the whole range of new and old treatment methods.

Management of Helicobacter pylori infection after gastric surgery

The Maastricht IV/Florence Consensus Report and the Second Asia-Pacific Consensus Guidelines strongly recommend eradication of Helicobacter pylori(H.pylori)in patients with previous gastric neoplasia who have undergone gastric surgery.However,the guidelines do not mention optimal timing,eradication regimens,diagnostic tools,and follow-up strategies for patients undergoing gastrectomy and do not indicate if eradication of H.pylori reduces the risk of marginal ulcer or stump cancer in the residual stomach after gastrectomy.The purpose of this review is to provide an update which may help physicians to properly manage H.pylori infection in patients who have undergone gastric surgery.This review focuses on(1)the microenvironment change in the stomach after gastrectomy;(2)the phenomenon of spontaneous clearance of H.pylori after gastrectomy;(3)the effects of H.pylori on gastric atrophy and intestinal metaplasia after gastrectomy;(4)incidence and clinical features of ulcers developing after gastrectomy;(5)does eradication of H.pylori reduce the risk of gastric stump cancer in the residual stomach?(6)does eradication of H.pylori reduce the risk of secondary metachronous gastric cancer in the residual stomach?and(7)optimal timing and regimens for H.pylori eradication,diagnostic tools and follow-up strategies for patients undergoing gastrectomy.

Small cell carcinoma of the gastric remnant：a case report

Objective Small cell carcinoma(SCC) is mostly found in the lungs. It is extremely rare in the gastric remnant. Here, we report a case and review the literature in order to improve the diagnosis and treatment of SCC of the gastric remnant.Methods We report a case of SCC of the gastric remnant in a 71-year-old male Chinese patient who presented with epigastric pain, acid regurgitation, and belching and who underwent Billroth II gastrectomy more than 38 years ago.Results Physical examination showed no obvious abnormalities. Laboratory data were within normal limits, except for anemia. Pathology of the mass showed a protruded tumor measuring 5.0 × 5.0 × 2.5 cm at the anastomotic edge of the gastric remnant that infiltrated through the full wall of the stomach; this was confirmed by immunohistochemical staining for cytokeratin [CK(-)], leukocyte common antigen(LCA)(+), synaptophysin(+), CD56(+), and Ki-67(+ > 50%).Conclusion SCC of the gastric remnant is extremely rare, although the pathology, symptoms, diagnosis, treatment, and prognosis of SCC are similar to those of gastric SCC. Although the standard treatment of SCC of the gastric remnant remains unclear, effective surgical resection and subsequent multiagent chemotherapy should be performed for long-term survival. Our case shows the efficacy of tegafurgimeracil-oteracil-potassium capsule chemotherapy. Examination of a large series is required to determine the optimal treatment strategy for SCC of the gastric remnant.

连续全层加固缝合十二指肠残端方案在胃癌根治术中的应用及生存质量分析

目的:探讨毕Ⅱ式胃癌根治手术中采用连续全层加固缝合十二指肠残端方案的手术效果及对术后生存质量的影响。方法:采取回顾性研究方案,选取我院2017年3月至2021年6月手术治疗的胃癌患者106例进行研究,根据患者手术过程中是否采取连续全层加固缝合十二指肠残端方案分为研究组60例(毕Ⅱ式胃癌根治手术+连续全层加固缝合十二指肠残端方案)、对照组46例(毕Ⅱ式胃癌根治手术+常规荷包加固缝合十二指肠残端或不加固缝合),对比两组患者的手术过程指标、胃肠道Visick分级、术后恢复情况、患者生存质量评分及手术并发症差异。结果:统计分析手术时间、消化道重建时间、手术出血量、术后肛门首次排气时间、术后首次进食时间、住院时间数据并进行对比,研究组和对照组患者之间差异无统计学意义(P>0.05);研究组和对照组患者的Visick分级分布情况比较,差异不具有统计学意义(P>0.05);研究组的手术并发症发生率8.33%低于对照组患者的28.26%,差异具有统计学意义(P<0.05);研究组患者的恶心呕吐症状评分低于对照组,差异具有统计学意义(P<0.05)。结论:毕Ⅱ式胃癌根治手术中采用连续全层加固缝合十二指肠残端方案有利于降低手术并发症率,一定程度上改善患者手术后的生存质量。

腹腔镜残胃癌根治术空肠R型代胃 食管-空肠三角吻合技术的应用研究

目的：探讨空肠＂R＂型代胃、食管-空肠三角吻合技术在腹腔镜下残胃癌根治术中的应用及其近期疗效。方法：回顾性分析2013年1月至2014年8月于本院实施腹腔镜残胃癌根治术空肠＂R＂型代胃、食管-空肠三角吻合手术的10例残胃癌患者（腹腔镜组）的临床资料,并与同期18例行开腹手术残胃癌切除术的患者（开腹组）临床病例资料进行对比。对患者术中、术后情况,淋巴结清扫数目、术后并发症、住院日、营养状况等进行分析研究,术后随访14~21个月。结果：10例患者均成功手术,无中转开腹患者,与开腹组相比,平均手术时间（210.0±30.9）min vs.（283.9±50.9）min,平均术中出血量（90.0±26.7）m L vs.（277.8±79.1）m L,平均清扫淋巴结数目（19.0±3.6）枚vs.（18.8±3.7）枚,术后首次下床时间（17.3±3.6）h vs.（75.8±15.7）h,术后首次进流食时间（1.6±0.4）d vs.5.7±1.3）d,胃肠道功能恢复时间（3.0±0.8）d vs.（7.2±1.3）d,术后平均住院时间（7.6±1.2）d vs.（20.8±3.9）d,腹腔镜组所有患者术后均未出现吻合口狭窄、反流性食管炎、吻合口出血、吻合口瘘、倾倒综合征、肠梗阻等并发症,无围手术期死亡,均顺利出院。返院复查患者营养状况良好,无进食哽噎感、食管后烧灼感等不适症状。结论：空肠＂R＂型代胃、食管-空肠三角吻合技术在腹腔镜下残胃癌根治术中的应用是安全、可行的,可提高患者术后生活质量,具有较好的近期疗效,同时可以达到与开腹手术相同的根治效果。

残胃癌外科手术治疗经验及消化道重建新方法

１９７２年１月～１９９６年１２月，收治残胃癌３９例，其发病率为１．８５％（３９／２１１０）。本文对其发生病因、发病率、外科处理及防治措施进行探讨。强调外科治疗要早诊早治。残胃癌要残胃全切除合并邻近脏器联合切除及Ｄ＋２、Ｄ３淋巴结廓清术。消化道重建方式推荐空肠原位间置代胃术、空肠Ｒｏｕｘ－Ｙ重建消化道新方法。才能取得满意疗效。

残胃癌32例临床诊治分析

[目的]研究广义残胃癌(gastric stump cancer,GSC)的预后情况和影响预后的相关因素。[方法]回顾性分析1999～2009年期间收治的32例GSC患者临床资料,所有病例全部经胃镜和CT确诊。发病距前次手术时间平均(375.75±131.47)月,其中消化性溃疡(411.56±109.47)月,胃癌(182.40±26.02)月。I期4例,II期8例,III期7例,IV期7例。行根治手术20例,姑息手术10例,未手术2例。手术方式中残胃全切加Roux-en-y吻合24例,残胃部分切除加Roux-en-y吻合2例,剖腹探查2例,造瘘术2例。[结果]32例患者中,无手术死亡病例。1、3、5年总生存率分别为71%,61%,36%。残胃癌TNM分期和手术是否根治是影响残胃癌预后的重要因素。Cox多因素分析显示,手术是否根治是唯一的预后影响因子。[结论]早期诊断和早期治疗,提高手术的根治率是改善GSC病人预后的关键。