Analyses of Clinicopathologic Characteristics for Remnant Gastric Cancer_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 , CHEN Jin ¹ , WU Chen ¹ , LIU Jun 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， General Hospital of Chinese People’s Liberation Army， Beijing 100021， China;

Corresponding author：

Keywords：

Stomach neoplasm; Remnant gastric cancer; Clinicopathologic characteristics; Gastroscopy

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Objective 　To analyze the clinicopathologic characteristics of remnant gastric cancer （RGC）.
Methods　 The clinical data of 114 patients with RGC treated in The Second Affiliated Hospital of Northern Sichuan Medical
College and The General Hospital of Chinese People’s Liberation Army from March 2000 to May 2008 were reviewed and analyzed retrospectively. The clinicopathologic characteristics between the patients with primary benign diseases and those with malignant diseases were evaluated.
Results 　A total of 114 cases，the age was （62.6±11.3） years，and the males versus females was 4.7∶1.0. Most patients （76.2%，64/84） were diagnosed at advanced stages （consistent with pT），and the proportion of pT1 stage cases was only 23.8% （20/84），tumor invasion pT4 was 60.7% （51/84）. It was more common that tumor directly invaded adjacent organs or structures （27.4%，23/84），lymph nodes positive （42.9%，36/84），and distant metastasis （27.2%，31/114）. The location of distant metastasis was usually confined in the abdominal cavity （93.5%，29/31），and the peritoneum disseminated was the most commonly structures （67.7%，21/31）. Histologically，the incidence of poorly differentiated adenocarcinoma （76.7%，79/103） was the mostly histologic grade as well as the diffuse type （78.6%，81/103） was the mostly Laurén classification. Between the patients with primary benign diseases and those with initial malignant disease，the initial gastrectomy or the methods of reconstruction had significantly differences （both P=0.000）. The median time from initial resection to development of RGC was 30.0 years in the patients with original benign disease，contrary to 3.3 years in those with previous malignant disease （P=0.000）. Both primary diseases （benign or malignant） and the age at initial gastrectomy were the major influencing factors for the time of RGC developed （P＜0.05）. For pathohistology characters，except signet-ring cell carcinoma （P=0.045）， pT4b （P=0.049），pN stage （P=0.025），and Borrmann classification （P=0.005），there were no significant differences between the patients with previous benign diseases and those with original malignant disease，as well as the resectability rate，curative resection （R0） rate，and overall survival rate （P＞0.05）.
Conclusions 　It is almost unaffected by originalbenign diseases or malignant diseases for clinicopathologic characteristics including the treatment option and prognostic factors.It is necessary and feasibility to form a pattern of endoscopic follow-up for RGC.

Citation： XIAO Shiming,CHEN Lin,PENG Zheng,JIANG Huaiwu,PENG Fangxing,CHEN Jin,WU Chen,LIU Jun,LUO Liang. Analyses of Clinicopathologic Characteristics for Remnant Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(11): 1191-1199. doi: Copy

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23.	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.
24.	Nunobe S， Ohyama S， Miyata S， et al. Incidence of gastric cancer in the remnant stomach after proximal gastrectomy[J]. Hepatogastroenterology， 2008， 55(86-87)：1855-1858.
25.	聂明明，申晓军，魏国，等. 残胃癌的临床病理特征及预后52例分析[J/OL]. 中华普外科手术学杂志(电子版)， 2010， 4(2)：144-148.
26.	Hu X， Tian DY， Cao L， et al. Progression and prognosis of gastricstump cancer[J]. J Surg Oncol， 2009， 100(6)：472-476.
27.	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.

1. 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.
2. Park JH， Lee JH， Rhee PL， et al. Endoscopic screening for remnant gastric cancer：points to be considered[J]. Gut Liver， 2007， 1(1)：22-26.
3. 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.
4. Nozaki I， Nasu J， Kubo Y，et al. Risk factors for metachronous gastric cancer in the remnant stomach after early cancer surgery[J]. World J Surg， 2010， 34(7)：1548-1554.
5. 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.
6. 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.
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. 钟晓刚，殷舞，麦威，等. 残胃癌外科治疗临床分析及再认识[J]. 中国普外基础与临床杂志， 2012， 19(1)：20-24.
9. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma：3rd English edition[J]. Gastric Cancer， 2011， 14(2)：101-112.
10. Sobin LH， Gospodarowicz MK， Wittekind C. TNM classification of malignant tumours[M]. 7th ed：Wiley-Blackwell， 2009.
11. Washington K， Berlin J， Branton P， et al. Protocol for the examination of specimens from patients with carcinoma of the stomach[DB/OL]. Stomach 3. 1. 0. 0 ed. College of American Pathologists， 2011. www. cap. org/cancerprotocols.
12. JGCA. Japanese classification of gastric carcinoma-2nd English edition[J]. Gastric Cancer， 1998， 1(1)：10-24.
13. Townsend CM， Beauchamp RD， Evers BM， et al. Sabiston textbook of surgery[M]. 18th ed. Saunders/Elsevier， 2007.
14. 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.
15. Hottenrott C. Remnant gastric cancer：can the risk be predicted when planning initial surgery?[J]. World J Surg， 2011， 35(2)：462-463.
16. 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.
17. 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.
18. Thorban S， Böttcher K，Etter M， et al. Prognostic factors in gastric stump carcinoma[J]. Ann Surg， 2000， 231(2)：188-194.
19. Takeno S， Noguchi T， Kimura Y， et al. Early and late gastric cancer arising in the remnant stomach after distal gastrectomy[J]. Eur J Surg Oncol， 2006， 32(10)：1191-1194.
20. Tanigawa N，Nomura E， Niki M， et al. Clinical study to identify specific characteristics of cancer newly developed in the remnant stomach[J]. Gastric Cancer， 2002， 5(1)：23-28.
21. Seoane A， Bessa X， Alameda F， et al. Role of helicobacter pyloriin stomach cancer after partial gastrectomy for benign ulcerdisease[J]. Rev Esp Enferm Dig， 2005， 97(11)：778-785.
22. Ohashi M， Katai H， Fukagawa T， et al. Cancer of the gastric stump following distal gastrectomy for cancer[J]. Br J Surg， 2007， 94(1)：92-95.
23. 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.
24. Nunobe S， Ohyama S， Miyata S， et al. Incidence of gastric cancer in the remnant stomach after proximal gastrectomy[J]. Hepatogastroenterology， 2008， 55(86-87)：1855-1858.
25. 聂明明，申晓军，魏国，等. 残胃癌的临床病理特征及预后52例分析[J/OL]. 中华普外科手术学杂志(电子版)， 2010， 4(2)：144-148.
26. Hu X， Tian DY， Cao L， et al. Progression and prognosis of gastricstump cancer[J]. J Surg Oncol， 2009， 100(6)：472-476.
27. 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analyses of Clinicopathologic Characteristics for Remnant Gastric Cancer

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