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

Abstract

Abstract: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 operation (radical resection vs palliative operation). Twenty-one cases that received radical resection were analyzed based on the 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%, x L 2 =11.48, 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 (43.0 m vs 13.0 m, x L 2 =36.31, P<0.01), the median survival time of stage IV patients with radical resection was 23.8 months. 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.

Clinical Significance of Tumor Location in Remnant Gastric Cancers Developed after Partial Gastrectomy for Primary Gastric Cancer

“…[11][12][13] This might be because of the recurrence patterns of gastric cancer; that is, distant metastasis to the liver, peritoneum, lung, and others is more common than loco-regional recurrence only. 3,14 The resectability of remnant gastric cancer is ultimately determined by the local aggressiveness of the disease.…”

Influência da invasão tumoral da linha de anastomose na sobrevivência de pacientes com câncer de coto gástrico

“…Houve invasão linfonodal regional e mesenterial com o acometimento tumoral da linha de anastomose, maior chance de óbito com esses eventos, porém menor probabilidade de recidiva tumoral quando havia invasão da linha de anastomose o dados estes concordantes com a literatura 4,22 . A fibrose da cicatriz cirúrgica da linha de anastomose pode interromper algumas vias de disseminação linfática para difusão da doença.…”

“…A doença descrita pela primeira vez em 1922 por Balfour e Tofgaard 30 , aumenta de incidência após 20 anos de gastrectomia33 e reconstrução gástrica, principalmente pela técnica a Billroth II 2,4,13,17 . Vários autores acreditam que a gastrectomia seja um estado pré-canceroso 6,8,10,19,20,25,26,29,34 .…”

Side effects during treatment of advanced gastric carcinoma by chemotherapy combined with CIK-cell transfusion in elderly people

“…In addition, the patients treated by autologous CIK cells had relatively lower grade 3 and grade 4 adverse events from chemotherapy, and fewer patients ceased chemotherapy due to severe toxicities, furthermore suggesting that CIK-cell therapy may improve patient endurance to chemotherapy. Gastric cancer in China is often diagnosed at a relatively advanced stage when metastases have occurred [3] . A series of treatments such as surgical resection combined with chemotherapy [9,10] , radiotherapy [4,11] , thermotherapy [12,13] and/or traditional Chinese medicine [14,15] have been introduced, but the 5-year survival rate of advanced gastric cancer patients remains very poor.…”

“…It is often diagnosed at a relatively late stage with local or long-distance metastasis [3] . The incidence of elderly people suffering from gastric cancer has increased in recent decades as life-span in China has become longer.…”