Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery

BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer(RGC)patients are crucial.A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively.Prognostic nutritional index(PNI),controlled nutritional status(CONUT),and Naples prognostic score(NPS)were calculated by preoperative blood indicators,including absolute lymphocyte count,lymphocyte to monocyte ratio,neutrophil to lymphocyte ratio,serum albumin,and serum total cholesterol.Patients with RGC were divided into groups according to the immune-nutritional risk.The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed.Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival(OS)rate between various immune-nutritional score groups.RESULTS The median age of this cohort was 70.5 years(ranging from 39 to 87 years).No significant correlation was found between most pathological features and immune-nutritional status(P>0.05).Patients with a PNI score<45,CONUT score or NPS score≥3 were considered to be at high immune-nutritional risk.The areas under the receiver operating characteristic curves of PNI,CONUT,and NPS systems for predicting postoperative survival were 0.611[95%confidence interval(CI):0.460–0.763;P=0.161],0.635(95%CI:0.485–0.784;P=0.090),and 0.707(95%CI:0.566–0.848;P=0.009),respectively.Cox regression analysis showed that the three immunenutritional scoring systems were significantly correlated with OS(PNI:P=0.002;CONUT:P=0.039;NPS:P<0.001).Survival analysis revealed a significant difference in OS between different immune-nutritional groups(PNI:75 mo vs 42 mo,P=0.001;CONUT:69 mo vs 48 mo,P=0.033;NPS:77 mo vs 40 mo,P<0.001).CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC,in which the NPS system has relatively effective predictive performance.

Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy

AIM： TO re-evaluate the recent clinicopathological fea- tures of remnant gastric cancer （RGC） and to develop desirable surveillance programs.METHODS： Between 1997 and 2008, 1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural Uni- versity of Medicine, Japan. Of these, 33 patients un- derwent gastrectomy with lymphadenectomy for RGC. Regarding the initial gastric disease, there were 19 patients with benign disease and 14 patients with gas- tric cancer. The hospital records of these patients were reviewed retrospectively. RESULTS： Concerning the initial gastric disease, the RGC group following gastric cancer had a shorter in- terval [P 〈 0.05; gastric cancer vs benign disease： 12 （2-22） vs 30 （4-51） years] and were more frequently reconstructed by Billroth- I procedure than those fol- lowing benign lesions （P 〈 0.001）. Regarding recon- struction, RGC following Billroth-]_l reconstruction showed a longer interval between surgical procedures [P 〈 0.001; Billroth-11 vs Billroth- I ： 32 （5-51） vs 12 （2-36） years] and tumors were more frequently associated with benign disease （P 〈 0.001） than those following Billroth- I reconstruction. In tumor location of RGC, after Billroth- I reconstruction, RGC occurred more fre- quently near the suture line and remnant gastric wall. After Billroth- 1I reconstruction, RGC occurred more fre- quently at the anastomotic site. The duration of follow- up was significantly associated with the stage of RGC （P 〈 0.05）. Patients diagnosed with early stage RGC such as stage Ⅰ-Ⅱ tended to have been followed up almost every second year. CONCLUSION： Meticulous follow-up examination and early detection of RGC might lead to a better prognosis. Based on the initial gastric disease and the procedure of reconstruction, an appropriate follow-up interval and programs might enable early detection of RGC.

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.

Current status in remnant gastric cancer after distal gastrectomy

Remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori(H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.

Clinicopathologic features of remnant gastric cancer over time following distal gastrectomy

AIM: To investigate remnant gastric cancer(RGC) at various times after gastrectomy, and lay a foundation for the management of RGC.METHODS: Sixty-five patients with RGC > 2 years and< 10 years after gastrectomy(RGC Ⅰ) and forty-nine with RGC > 10 years after gastrectomy(RGC Ⅱ) who underwent curative surgery were enrolled in the study.The clinicopathologic factors, surgical outcomes, and prognosis were compared between RGC Ⅰ and RGC Ⅱ.RESULTS: There was no significant difference in surgical outcomes between RGC Ⅰ and RGC Ⅱ. For patients reconstructed with Billroth Ⅱ, significantly more patients were RGC Ⅱ compared with RGC(71.9%vs 21.2%, P < 0.001), and more RGC Ⅱ patients had anastomotic site locations compared to RGC Ⅰ(31.0%vs 56.3%, P = 0.038). The five-year survival rates for the patients with RGC Ⅰ and RGC Ⅱ were 37.6%and 47.9%, respectively, but no significant difference was observed. Borrmann type and tumor stage were confirmed to be independent prognostic factors in both groups.CONCLUSION: RGC Ⅱ is located on the anastomotic site in higher frequency and more cases develop after Billroth Ⅱ reconstruction than RGC Ⅰ.

Current controversies in treating remnant gastric cancer: Are minimally invasive approaches feasible?

The incidence of remnant gastric cancer(RGC)is still increasing.Minimally invasive approaches including endoscopic resection,laparoscopic and robotic approaches,and function-preserving gastrectomy have been utilized as curative treatment methods for primary gastric cancer.However,adhesions and anatomical alterations due to previous gastrectomy make the use of minimally invasive approaches complicated and difficult for RGC.Application of these approaches for the treatment of RGC is still controversial.Endoscopic submucosal dissection is a favorable alternative therapy for the resection of early gastric cancer that occurs in the remnant stomach and can prevent unnecessary complications.The majority of retrospective studies have shown that endoscopic submucosal dissection is an effective and oncologically safe treatment modality for RGC.Subtotal gastrectomy could serve as a function-preserving gastrectomy for patients with early RGC and improve postoperative late-phase function.However,there are only two studies that demonstrate the feasibility and oncological efficacy of subtotal gastrectomy for RGC.The non-randomized controlled trials showed that compared to open gastrectomy,laparoscopic gastrectomy for RGC led to better short-term outcomes and similar oncologic results.Because of the rarity of RGC,future multicenter studies are required to determine the indications of minimally invasive treatment for RGC.

Predictive value of positive lymph node ratio in patients with locally advanced gastric remnant cancer

BACKGROUND Traditional lymph node stage(N stage)has limitations in advanced gastric remnant cancer(GRC)patients;therefore,establishing a new predictive stage is necessary.AIM To explore the predictive value of positive lymph node ratio(LNR)according to clinicopathological characteristics and prognosis of locally advanced GRC.METHODS Seventy-four patients who underwent radical gastrectomy and lymphadenectomy for locally advanced GRC were retrospectively reviewed.The relationship between LNR and clinicopathological characteristics was analyzed.The survival analysis was performed using Kaplan-Meier survival curves and Cox regression model.RESULTS Number of metastatic LNs,tumor diameter,depth of tumor invasion,Borrmann type,serum tumor biomarkers,and tumor-node-metastasis(TNM)stage were correlated with LNR stage and N stage.Univariate analysis revealed that the factors affecting survival included tumor diameter,anemia,serum tumor biomarkers,vascular or neural invasion,combined resection,LNR stage,N stage,and TNM stage(all P<0.05).The median survival time for those with LNR0,LNR1,LNR2 and LNR3 stage were 61,31,23 and 17 mo,respectively,and the differences were significant(P=0.000).Anemia,tumor biomarkers and LNR stage were independent prognostic factors for survival in multivariable analysis(all P<0.05).CONCLUSION The new LNR stage is uniquely based on number of metastatic LNs,with significant prognostic value for locally advanced GRC,and could better differentiate overall survival,compared with N stage.

Gastric cancer arising from the remnant stomach after distal gastrectomy:A review

Gastric stump carcinoma was initially reported by Balfore in 1922,and many reports of this disease have since been published. We herein review previous reports of gastric stump carcinoma with respect to epidemiology,carcinogenesis,Helicobacter pylori(H. pylori) infection,Epstein-Barr virus infection,clinicopathologic characteristics and endoscopic treatment. In particular,it is noteworthy that no prognostic differences are observed between gastric stump carcinoma and primary upper third gastric cancer. In addition,endoscopic submucosal dissection has recently been used to treat gastric stump carcinoma in the early stage. In contrast,many issues concerning gastric stump carcinoma remain to be clarified,including molecular biological characteristics and the carcinogenesis of H.pylori infection.We herein review the previous pertinent literature and summarize the characteristics of gastric stump carcinoma reported to date.

Expression profiles of gastric cancer molecular subtypes in remnant tumors

BACKGROUND Remnant gastric cancer(RGC)is a carcinoma arising in the stomach remnant after previous gastric resection.It is frequently reported as a tumor with a poor prognosis and distinct biological features from primary gastric cancer(PGC).However,as it is less frequent,its profile regarding the current molecular classifications of gastric cancer has not been evaluated.AIM To evaluate a cohort of RGC according to molecular subtypes of GC using a panel of immunohistochemistry and in situ hybridization to determine whether the expression profile is different between PGC and RGC.METHODS Consecutive RGC patients who underwent gastrectomy between 2009 and 2019 were assessed using seven GC panels:Epstein-Barr virus in situ hybridization,immunohistochemistry for mismatch repair proteins(MutL homolog 1,MutS homolog 2,MutS homolog 6,and PMS1 homolog 2),p53 protein,and E-cadherin expression.Clinicopathological characteristics and survival of these patients were compared to 284 PGC patients.RESULTS A total of 40 RGC patients were enrolled in this study.Compared to PGC,older age(P<0.001),male(P<0.001),lower body mass index(P=0.010),and lower hemoglobin level(P<0.001)were associated with RGC patients.No difference was observed regarding Lauren’s type and pathologic Tumor Node Metastasis stage between the groups.Regarding the profiles evaluated,EBV-positive tumors were higher in RGC compared to PGC(P=0.039).The frequency of microsatellite instability,aberrant p53 immunostaining,and loss of E-cadherin expression were similar between RGC and PGC.Higher rates of simultaneous alterations in two or more profiles were observed in RGC compared to PGC(P<0.001).According to the molecular classification,the subtypes were defined as EBV in nine(22.5%)cases,microsatellite instability in nine(22.5%)cases,genomically stable in one(2.5%)case,and chromosomal instability in 21(52.5%)cases.There was no significant difference in survival between molecular subtypes in RGC patients.CONCLUSION RGC was associated with EBV positivity and higher rates of co-altered expression profiles compared to PGC.According to the molecular classification,there was no significant difference in survival between the subtypes of RGC.

Relationship between Gastric Stasis in the Remnant Stomach and Interdigestive Migrating Complex in Patients after Pylorus-Preserving Gastrectomy for Gastric Cancer

Objectives: The demerit of pylorus-preserving gastrectomy (PPG) is gastric stasis in the remnant stomach (GSRS). We investigated the relationship between postgastrectomy disorder (PGD), especially GSRS, and interdigestive migrating complex (IMC) in PPG patients. Background: The cause of GSRS is still unknown. Therefore, we studied relationship between GSRS and IMC. Methods: 24 PPG patients (16 men and 8 women;mean, 61.2 years) were divided into groups A (12 patients without GSRS) and B (12 patients with GSRS). The relationship between GSRS and IMC was studied. Results: Length of the antral cuff (LAC) was significantly longer in group A than group B (P < 0.0001). IMC and appetite were significantly more common in group A than in group B (P = 0.0465, P = 0.0186, respectively). Postprandial abdominal fullness (PAF) was significantly more common in group B than in group A (P = 0.0061). Reflux esophagitis (RE) and body weight loss were found in group B more than in group A. Dumping syndrome was not found in either group. Endoscopic gastritis was found significantly more in group B than in group A (P = 0.0047). Conclusions: In PPG patients with a short LAC, GSRS may occur by the decrease of IMC occurrence.

A New Early Gastric Cancer after Subtotal Gastric Resection for Early Cancer: Case Report and Review of the Literature

Although the prognosis of early gastric cancer (EGC) is considered to be satisfactory, some patients experience tumor relapse after curative surgery. Both pathogenesis and risk factors of recurrence remain unclear. We describe a case report of a 49-year-old male who underwent subtotal gastric resection D2A for angular gastric cancer. Histological examination revealed gastric adenocarcinoma with low grade of differentiation and colloid areas, intramucosal, and absence of neoplastic proliferation in the surgical margins, in omental stroma and in the six examined lymph nodes (pT1, pN0). 11 years later, the same patient underwent D2 total gastrectomy for gastric cancer in the remnant stomach. New histological examination revealed again gastric adenocarcinoma, intramucosal, medium degree of differentiation, no documentable neoplastic proliferation within the limits of surgical resection, in the thirty-three examined lymph nodes and in the omentum (pT1, pN0).

胃良性疾病患者行远端胃切除术后发生残胃癌和食管癌的危险因素分析

目的:探讨胃良性疾病患者行远端胃切除术后残胃癌和食管癌发生的相关危险因素。方法:回顾性分析2010年01月01日至2018年01月01日因胃良性疾病在我院行远端胃切除术的患者的病历资料,采用单因素分析和多因素logistic回归模型确定术后残胃癌和食管癌发生的独立危险因素,并建立远端胃切除术后食管癌、残胃癌发生风险的预测模型。结果:共纳入301例患者,残胃癌患者占11.96%,平均年龄(67.83±9.14)岁,其中进展期患者占83.33%,且只有55.56%的患者有手术机会,残胃癌多见于残胃体及吻合口。5.00%的患者发生了食管癌,平均年龄(68.00±8.73)岁,多见于食管下1/3段,均为进展期,且80.00%失去了手术机会。单因素和二元logistic回归分析显示,年龄≥65岁、手术间隔≥10年和胆汁反流是残胃癌的独立危险因素,年龄≥65岁和胆汁反流是食管癌的独立危险因素。将残胃癌和食管癌发生风险分为低危、中危、高危组,残胃癌在各组发生率分别为1.72%、8.62%、28.99%(P<0.001),食管癌分别为0.70%、4.88%、13.16%(P<0.001)。结论:年龄≥65岁、手术间隔≥10年的因胃良性疾病行远端胃切除术后的患者,建议密切进行胃镜随访。如发现胆汁反流,应仔细检查食管下1/3段、残胃体及吻合口。

3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study

BACKGROUND Three-dimensional(3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach(CRS), but its clinical efficacy remains controversial.AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy(3DLAG) with open gastrectomy(OG) for CRS.METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up,we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival(OS) rates were compared between the two groups.RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score,initial disease state(benign or malignant), primary surgical anastomosis method,interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss(188.33 ± 191.35 mL vs 305.83 ± 303.66 mL;P =0.045) and smaller incision(10.86 ± 3.18 cm vs 20.06 ± 5.17 cm;P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG(14.0 ± 7.17 vs 10.73 ± 6.82;P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups(1.56 ± 2.84 vs 2.35 ± 5.28;P = 0.413). The complication rate(8.3% vs 20.8%;P = 0.207) and intensive care unit admission rate(5.6% vs 14.5%;P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval(CI): 72.4%-95.6%] and 73.3%(95%CI: 60.0%-89.5%)respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3%(95%CI: 76.4%-99.8%) and 75.6%(95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups(P = 0.68).CONCLUSION Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.

Esophageal reconstruction with remnant stomach:A case report and review of literature

The number of patients developing esophageal cancer after gastrectomy has increased.However,gastric remnant is very rarely used for reconstruction in esophageal cancer surgery because of the risk of anastomotic leakage resulting from insufficient blood flow.We present a case of esophageal cancer using gastric remnant for esophageal substitution after distal gastrectomy in a 57-year-old man who presented with a 1-month history of mild dysphagia and a background history of alcohol abuse.Gastroscopy showed a 1.2 cm × 1.0 cm bulge tumor of the lower third esophagus with the upper margin located 39 cm from the dental arcade.Computed tomography of the chest showed lower third esophageal wall thickening.The patient underwent en bloc radical esophagectomy with a two-field lymph node dissection of the upper abdomen and mediastinum via a left-sided posterolateral thoracotomy through the seventh intercostal space.The upper end of the esophagus was resected 5 cm above the tumor.The gastric remnant was used for reconstruction of the esophago-gastrostomy and placed in the left thoracic cavity.The patient started a liquid diet on postoperative day 8 and was discharged on the 10 th postoperative day without complications.In this report,we demonstrate that the gastric remnant may be used for reconstruction in patients with esophageal cancer as a substitute organ after distal gastrectomy.

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.

45例残胃癌诊治的临床分析

目的:探讨残胃癌的临床病理特征,诊治方法及预后相关因素。方法:分析我院近20年来收治的45例残胃癌的临床病理资料。结果:残胃癌位于吻合口28例,贲门9例,其它部位8例;组织学类型:未分化腺癌1例;低分化腺癌36例;中分化腺癌7例;高分化腺癌1例。根治性切除组1、3、5年生存率分别为100%、78.8%、47.2%;非根治性切除组非治愈性切除患者的1、3、5年生存率分别为62.5%、25.0%和0。未切除的10例患者,均于2年内死亡,平均生存时间为12个月。各期病例5年生存率分别为Ⅰ期100.0%、Ⅱ期75.0%、Ⅲ期17.8%、Ⅳ期0。结论:残胃癌多发生于BillrothⅡ式胃大部切除术后10年以上。残胃癌的预后与病理分期和能否行根治性切除密切相关。

根治性切除术后残胃癌的预后分析及与近端胃癌预后的配对比较

目的:残胃癌与近端胃癌都发生于胃上部黏膜,但由于残胃特殊的内环境,两者临床病理特征与预后有着显著差异。本研究分析了残胃癌的预后影响因素,比较残胃癌与近端胃癌的预后差异。方法:对83例在1991年7月至2008年7月期间在天津市肿瘤医院行根治术的残胃癌患者的临床资料进行预后分析,并与同期83例近端胃癌患者进行回顾性配对对照研究,比较两组预后差异。结果:残胃癌预后单因素分析中肿瘤直径、TNM分期、浸润深度、淋巴结转移是影响残胃癌预后的相关因素(P<0.05);Cox回归中TNM分期及浸润深度(T分期)是影响残胃癌预后的独立因素(P<0.05),TNM分期及T分期越晚预后越差。残胃癌与近端胃癌的配对研究中,残胃癌行联合脏器切除28例,明显高于近端胃癌(P=0.022)。根治性切除术后残胃癌的中位生存期为33.4个月,长于近端胃癌,其1、3、5年生存率分别为90%、49%、22%,亦高于近端胃癌(P=0.042)。结论:临床病理分期相同的残胃癌比近端胃癌预后较好,根治性切除术后残胃癌患者亦能达到较好的预后。

残胃癌的淋巴结转移规律及外科治疗

目的探讨残胃癌临床病理学特性和淋巴结转移规律,以及根治性外科手术切除范围。方法回顾性分析32例残胃癌的临床病理学特征、淋巴结转移规律以及手术治疗效果。结果本组残胃癌占同期收治胃癌的4.07%,其中Ⅰ期4例,Ⅱ期7例,Ⅲ期11例,Ⅳ期10例。根治性切除率为77.27%,联合脏器切除率为54.5%,全胃切除31例,剖腹探查1例,全胃切除后消化道再建用Roux-en-Y术式。经腹腔完成残胃癌根治手术26例,经胸腹联合切口完成残胃癌根治手术6例。淋巴结转移率为63.63%,淋巴结转移站别分别为:pN08例,pN116例,pN27例,pN31例。残胃癌Ⅰ期和Ⅱ期平均生存时间为(80.17±17.21)个月,中位生存时间为(56.12±19.52)个月;残胃癌Ⅲ期平均生存时间为(31.16±9.15)个月,中位生存时间为(22.0±13.70)个月;残胃癌Ⅳ期平均生存时间为(23.55±6.08)个月,中位生存时间为(16.30±15.30)个月,Log Rank=0.0468,差异有统计学意义(P<0.05)。比较单纯残胃癌根治组与联合脏器切除组、姑息手术组与标准根治手术组及扩大根治手术组、初次胃手术再建为BillrothⅠ与BillrothⅡ、高中分化腺癌组与低分化腺癌组,淋巴结转移阳性与阴性差异都有统计学意义(P<0.05)。结论对残胃癌外科治疗应选择在全胃切除D2淋巴结清扫基础上进行扩大根治手术和联合脏器切除。

不同手术方式在残胃癌中的综合效果比较

目的:比较不同手术方式在残胃癌中的综合效果。方法:选取2006年1月～2007年12月于本院进行治疗的48例残胃癌患者为研究对象,将其根据手术方式的不同分为A组(D2术式组)24例和B组(D3术式组)24例,然后将两组患者的平均生存时间、1、2、3、5年生存率及手术前、手术后1、3个月的氧化应激指标及血清肿瘤标志物水平进行统计及比较。结果:B组的平均生存时间长于A组,1、2、3、5年生存率高于A组,术后1个月的血清氧化应激指标差于A组,而术后3个月优于A组,术后3个月肿瘤标志物水平低于A组,P均<0.05,均有显著性差异。结论:D3术式在残胃癌患者中的综合效果较佳,对于残胃癌患者的临床价值更高。

胃大部分切除术后残胃癌26例临床诊治分析

目的:探讨残胃癌的早期诊断方法和外科治疗,观察不同手术方式对预后的影响。方法:对26例残胃癌的临床病理资料进行回顾性分析,比较胃镜和钡餐对残胃癌的诊断价值。结果:胃镜对残胃癌的诊断率为80.8%,钡餐为50.0%。手术切除的20例中根治性残胃切除13例均生存≥3年;姑息性切除7例,术后生存2年5例,1.5年2例。行胃空肠吻合4例中3例于6个月内死亡,1例生存10个月。2例腹腔内广泛转移者仅行肿块活检术。结论:胃镜对残胃癌的诊断价值优于钡餐。早期诊断并行根治性残胃切除患者预后较好。