Objective To analyze surgical treatment and clinicopathologic features of remnant gastric cancer,and to recognize the strategies of treatment.
Methods The clinical data of 26 cases patients with remnant gastric cancer diagnosed by endoscopy and pathological examination and underwent surgical treatment were retrospectively analyzed in our hospital between January 2004 and March 2011.In this study,14 cases of remnant gastric cancer from benign disease （RGCB） and 12 cases of remnant gastric cancer after stomach cancer operation （RGCC） were included.The clinical findings,Helicobacter pylori （HP） infection,surgical methods, histopathological features,and prognosis were analyzed.
Results The patients developed a carcinoma in the gastric remnant about 15-44 years after operation for benign disease （median 26.3 years） and about 1-10.5 years after gastric cancer operation （median 4 years）,and there was significant differences of the two groups（P＜0.05）.HP infection of the gastric remnant was found in 73.1%（19/26） patients,and infection rate of patients was 71.4%（10/14） in RGCB and 75.0%（9/12） in RGCC, but there was no statistical different in two groups （P＞0.05）.All 26 patients underwent surgical procedure,and the rate of radical resection was 46.2% （12/26）, which was 57.1% （8/14） in RGCB and 33.3% （4/12） in RGCC respectively,there was no statistical different （P＞0.05）.Among the 12 cases underwent radical resection, the highest lymphatic metastasis rate was in No.3 group （83.3%， 10/12）,which came in second in lymph node of mesojejunum or splenic hilum （33.3%， 4/12）.Postoperative pathological staging was as follows：stageⅠin 3 cases, stageⅡ in 2 cases, stage Ⅲ in 14 cases and stage Ⅳ in 7 cases. In 18 patients underwent tumor excision,the metastasis of lymph node occurred in 13 cases （72.2%）,and the pancreas,transverse colon,or spleen were invaded in 13 cases according to histopathological results. Meanwhile,peritoneal metastasis were founded in 8 cases patients,and the peritoneal metastasis rate of patients with RGCB （14.3%；2/14） was significantly lower than that with RGCC （50.0%， 6/12）, P＜0.05.The overall one-year survival rate and three-year survival rate was 54.5% and 38.5%,respectively, and the survival time was 2-61 months （median 12 months）.Survival analysis indicated that pathological stage and radical resection were significant prognostic factors for patients with remnant gastric cancer（P＜0.01）,and radical resection was an independent prognostic factor （P＜0.05）,while age,gender,disease of first operation, degree of differentiation and HP infection were not （P＞0.05）.
Conclusions Early detection and standard radical resection are the key factor to improve the prognosis of patients with remnant gastric cancer and laparoscopic exploration may minimize unnecessary injures of surgery.Because of the different clinical characteristics,strategy of treatment for RGCC and RGCB shall be discriminatory.
Citation： ZHONG Xiaogang,YIN Wu,MAI Wei,QIN Qianzi,HUANG Shunrong.. Clinical Analysis and Recognition on Surgical Treatment of Remnant Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(1): 20-24. doi: Copy