Analysis of Treatment and Prognosis of Gastric Stump Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIAO Shiming ¹ ,  CHEN Lin ² , PENG Zheng ² , JIANG Huaiwu ¹ , PENG Fangxing ¹ , WU Chen ¹ , LIU Jun ¹ , CHEN Jin ¹ , LUO Liang ¹

1.Department of Gastrointestinal Surgery， The Second Affiliated Hospital of Northern Sichuan Medical College， Mianyang 621000， Sichuan Province， China;;
2.Department of General Surgery， The General Hospital of Chinese People’s Liberation Army，Beijing 100021， China;

Corresponding author：

CHEN Lin, Email: chenlinbj@vip.sina.com

Keywords：

Gastric stump carcinoma; Surgery; Prognosis

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Objective 　To summarize and analyze the treatment options and prognostic factors of gastric stump carcinoma （GSC）.
Methods 　The clinical data of 114 patients with GSC treated in The Second Affiliated Hospital of Northern Sichuan Medical College and The General Hospital of Chinese People’s Liberation Army from Mar. 2000 to May.2008 were reviewed， and influencing factors of surgical resection and prognosis were analyzed.
Results 　For all patients，the ratios of surgical resection and curative resection（R0 resection） were 57.0%（65/114） and 54.4% （62/114）， respec-tively. The ratios of total gastrectomy， distal gastrectomy， proximal gastrectomy， endoscopic mucosal resection （EMR），and endoscopic submucosal dissection （ESD） were 73.8%（48/65）， 16.9%（11/65）， 3.1%（2/65）， 4.6%（3/65）， and 1.5%（1/65）in resection cases， and were 75.8%（47/62）， 16.1%（10/62）， 3.2%（2/62）， 4.8%（3/62）， and 0 in R0 resection cases， respectively. Seventy-five patients were followed-up for 0.3-79 months （median 12 months）， the median
survival time was 19.5 months， and 1-， 3-， and 5-year overall survival rates were 61.8%， 42.3%， and 30.1%， respectively. The results of multivariate analysis showed that resection rate was higher in patients with initial distal
gastrectomy （P=0.002）， kps score≥80 （P=0.016）,lower macroscopic type （P=0.013）， and cM0 （P=0.000）. R0 resection （P=0.000）， macroscopic type （P=0.005）， and cT stage （P=0.006） were the independent prognostic factors. There were both no significant difference on survival between the patients with previous benign disease and those with original malignant disease when analyzed with univariate or multivariate method （P＞0.05）. There were no significant difference on overall survival curve among patients treated with palliative resection， palliative chemotherapy， simple laparotomy， and best supportive care （P＞0.05）.
Conclusions 　The treatment options and prognosis of GSC were not influenced by the primary benign diseases or malignant diseases， and R0 resection is the most important prognostic factor. Removal of total remnant stomach is the best surgical procedure for GSC， and palliative laparotomy should be avoided.

Citation： XIAO Shiming,CHEN Lin,PENG Zheng,JIANG Huaiwu,PENG Fangxing,WU Chen,LIU Jun,CHEN Jin,LUO Liang. Analysis of Treatment and Prognosis of Gastric Stump Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(12): 1307-1318. doi: Copy

1.	陈凛，王宁. 残胃癌的流行病学及预防有关问题[J]. 中国实用外科杂志， 2009， 29(10)：806-807.
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14.	Thorban S， Böttcher K， Etter M， et al. Prognostic factors ingastric stump carcinoma[J]. Ann Surg， 2000， 231(2)：188-194.
15.	Sasako M， Maruyama K， Kinoshita T， et al. Surgical treatment of carcinoma of the gastric stump[J]. Br J Surg， 1991， 78(7)：822-824.
16.	周立新，张则伟，徐志远. 残胃癌的外科治疗与预后分析[J]. 癌症， 2009， 28(5)：511-514.
17.	胡祥，田大宇，曹亮. 残胃癌的临床病理学特征和预后[J]. 中华胃肠外科杂志， 2009， 12(6)：581-583.
18.	李昉璇，张汝鹏，赵敬柱，等. 残胃癌临床病理特征与预后因素分析[J]. 中华外科杂志， 2011， 49(3)：204-207.
19.	韩方海，詹文华，李玉明，等. 残胃癌的外科治疗及预后分析[J]. 中华胃肠外科杂志， 2009， 12(1)：28-31.
20.	诸葛勇华，陶厚权，邵钦树，等. 复发性胃癌患者再手术的治疗价值[J]. 中华医学杂志， 2010， 90(17)：1184-1186.
21.	Tanigawa N， Nomura E， Lee SW， et al. Current state of gastric stump carcinoma in Japan：based on the results of a nationwide survey[J]. World J Surg， 2010， 34(7)：1540-1547.
22.	Ohyama S， Tokunaga M， Hiki N， et al. A clinicopathological study of gastric stump carcinoma following proximal gastrectomy[J]. Gastric Cancer， 2009， 12(2)：88-94.
23.	Hoteya S， Iizuka T， Kikuchi D， et al. Clinical advantages of endoscopic submucosal dissection for gastric cancers in remnant stomach surpass conventional endoscopic mucosal resection[J]. Dig Endosc， 2010， 22(1)：17-20.
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25.	Takenaka R， Kawahara Y， Okada H， et al. Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy[J]. Gastrointest Endosc， 2008， 67(2)：359-363.
26.	Schaefer N， Sinning C， Standop J， et al. Treatment and prognosisof gastric stump carcinoma in comparison with primary proximalgastric cancer[J]. Am J Surg， 2007， 194(1)：63-67.
27.	肖仕明，陈凛，彭正，等. 残胃癌的临床病理学特征分析(附114例报道)[J]. 中国普外基础与临床杂志， 2012， 19(11)：1191-1199.

1. 陈凛，王宁. 残胃癌的流行病学及预防有关问题[J]. 中国实用外科杂志， 2009， 29(10)：806-807.
2. Ahn HS， Kim JW， Yoo MW， et al. Clinicopathological features and surgical outcomes of patients with remnant gastric cancer after a distal gastrectomy[J]. Ann Surg Oncol， 2008， 15(6)：1632-1639.
3. An JY， Youn HG， Ha TK， et al. Clinical significance of tumor location in remnant gastric cancers developed after partial gastrectomy for primary gastric cancer[J]. J Gastrointest Surg， 2008， 12(4)：689-694.
4. Firat O， Guler A， Sozbilen M， et al. Gastric remnant cancer：an old problem with novel concerns[J]. Langenbecks Arch Surg， 2009， 394(1)：93-97.
5. Katsios CS. Metachronous cancer in the stomach remnant[J]. World J Surg， 2011， 35(2)：465-466.
6. Balfour DC. Factors influencing the life expectancy of patients operated on for gastric ulcer[J]. Ann Surg， 1922， 76(3)：405-408.
7. 胡祥. 第14版日本《胃癌处理规约》的重要变更[J]. 中国实用外科杂志， 2010，30(4)：241-246.
8. NCCN Panel. NCCN guidelines，gastric cancer[DB/OL].National Comprehensive Cancer Network， 2012， http：//www.nccn. org/professionals/physician_gls/pdf/gastric. pdf.
9. Washington K. 7th edition of the AJCC cancer staging manual：stomach[J]. Ann Surg Oncol， 2010， 17(12)：3077-3079.
10. Washington K， Berlin J， Branton P， et al. Protocol for theexamination of specimens from patients with carcinoma of the stomach[DB/OL]. College of American Pathologists， 2011， www.cap.org/cancerprotocols.
11. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma-2nd English edition[J]. Gastric Cancer， 1998， 1(1)：10-24.
12. Townsend CM， Beauchamp RD， Evers BM， et al. Sabiston textbook of surgery[M]. 17th ed. Saunders：Elsevier， 2004：1305.
13. Mezhir JJ， Gonen M， Ammori JB， et al. Treatment and outcome of patients with gastric remnant cancer after resection for peptic ulcer disease[J]. Ann Surg Oncol， 2011， 18(3)：670-676.
14. Thorban S， Böttcher K， Etter M， et al. Prognostic factors ingastric stump carcinoma[J]. Ann Surg， 2000， 231(2)：188-194.
15. Sasako M， Maruyama K， Kinoshita T， et al. Surgical treatment of carcinoma of the gastric stump[J]. Br J Surg， 1991， 78(7)：822-824.
16. 周立新，张则伟，徐志远. 残胃癌的外科治疗与预后分析[J]. 癌症， 2009， 28(5)：511-514.
17. 胡祥，田大宇，曹亮. 残胃癌的临床病理学特征和预后[J]. 中华胃肠外科杂志， 2009， 12(6)：581-583.
18. 李昉璇，张汝鹏，赵敬柱，等. 残胃癌临床病理特征与预后因素分析[J]. 中华外科杂志， 2011， 49(3)：204-207.
19. 韩方海，詹文华，李玉明，等. 残胃癌的外科治疗及预后分析[J]. 中华胃肠外科杂志， 2009， 12(1)：28-31.
20. 诸葛勇华，陶厚权，邵钦树，等. 复发性胃癌患者再手术的治疗价值[J]. 中华医学杂志， 2010， 90(17)：1184-1186.
21. Tanigawa N， Nomura E， Lee SW， et al. Current state of gastric stump carcinoma in Japan：based on the results of a nationwide survey[J]. World J Surg， 2010， 34(7)：1540-1547.
22. Ohyama S， Tokunaga M， Hiki N， et al. A clinicopathological study of gastric stump carcinoma following proximal gastrectomy[J]. Gastric Cancer， 2009， 12(2)：88-94.
23. Hoteya S， Iizuka T， Kikuchi D， et al. Clinical advantages of endoscopic submucosal dissection for gastric cancers in remnant stomach surpass conventional endoscopic mucosal resection[J]. Dig Endosc， 2010， 22(1)：17-20.
24. Lee JY， Choi IJ， Cho SJ， et al. Endoscopic submucosal dissectionfor metachronous tumor in the remnant stomach after distal gastrectomy[J]. Surg Endosc， 2010， 24(6)：1360-1366.
25. Takenaka R， Kawahara Y， Okada H， et al. Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy[J]. Gastrointest Endosc， 2008， 67(2)：359-363.
26. Schaefer N， Sinning C， Standop J， et al. Treatment and prognosisof gastric stump carcinoma in comparison with primary proximalgastric cancer[J]. Am J Surg， 2007， 194(1)：63-67.
27. 肖仕明，陈凛，彭正，等. 残胃癌的临床病理学特征分析(附114例报道)[J]. 中国普外基础与临床杂志， 2012， 19(11)：1191-1199.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Treatment and Prognosis of Gastric Stump Carcinoma

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