Clinical study to identify specific characteristics of cancer newly developed in the remnant stomach.
Clinical study to identify specific characteristics of cancer newly developed in the remnant stomach.
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DOI：
10.1007/s101200200003
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发表时间：
2002-01-01
期刊：
影响因子：
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通讯作者：
Morita, Shinsho
中科院分区：
文献类型：
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作者：
Tanigawa, Nobuhiko;Nomura, Eiji;Morita, Shinsho
背景：胃部分切除术后残胃新发肿瘤（CRS）不仅是一种典型的癌变模式，而且在肿瘤诊断方面都值得关注。方法：1979 ~ 1998年共治疗47例CRS患者。我们回顾了临床病理变量以及第二次手术后的长期生存结果，以澄清与通常的原发性胃癌相比，该疾病实体的特征是否有任何差异。结果：既往有胃良性病变的CRS患者首次手术至手术的平均时间间隔为25.8年，既往有胃癌的CRS患者为10.6年。在既往癌症患者和采用Billroth I法重建的患者（无论疾病的原发性质如何）中，CRS经常在早期被检测到。组织学分化的癌症在因癌症而接受过初始手术的患者中发展得更为频繁。第二次手术后的长期生存结果清楚地表明，CRS的手术治疗与原发性上胃癌（PUC）的手术治疗同样有效。此外，证实在初次胃手术后出现新的淋巴引流至下纵隔或空肠肠系膜。结论：虽然CRS患者淋巴结转移到下纵隔和/或空肠肠系膜的发生率较高，但研究结果提示CRS患者与PUC患者的治疗应相似。
BACKGROUND: Cancer newly developed in the remnant stomach (CRS) after partial gastrectomy is worthy of attention not only because it is a typical model of carcinogenesis but also from the aspect of cancer diagnosis.METHODS: We treated 47 patients with CRS in the 20 years from 1979 to 1998. Clinicopathological variables, as well as long-term survival results after the second surgery, were reviewed to clarify whether there were any differences in the characteristics of this disease entity compared with the usual primary gastric cancer.RESULTS: The mean time interval between the initial surgery and surgery for CRS was 25.8 years for patients with CRS with previous benign gastric lesions, and 10.6 years for those with previous gastric cancer. CRS was frequently detected at an early stage in the patients with previous cancer, and in the patients who had undergone reconstruction by the Billroth I method (regardless of the primary nature of the disease). Cancers with a differentiated histology developed more frequently in the patients who had undergone the initial surgery for cancer disease. Long-term survival results after the second surgery clearly demonstrated that surgical treatment for CRS was as effective as that for primary cancer in the upper stomach (PUC). In addition, it was confirmed that new lymphatic drainage into the lower mediastinum or the jejunal mesentery had developed after the initial gastric surgery.CONCLUSION: The findings suggested that patients with CRS and those with PUC should be treated similarly, although the findings of a high incidence of lymph node metastasis to the lower mediastinum and/or to the jejunal mesentery in the CRS patients should be taken into consideration.