The Biological Behavior And Surgical Treatment Of Gsc And Recurrent Gastric Stump Cancer (Attached 211 Cases Of Patients Analysis)

Objective:This study retrospectively analyzed and summarized the GSC and Recurrent gastric stump cancer clinical information, surgical treatment and postoperative follow-up, to investigate the GSC and Recurrent gastric stump cancer biological behavior and treatment methods, improve the clinical to the understanding of these diseases, to improve treatment effect, prolonged survival to provide a theoretical basis and objective basis for clinical.Methods:In January 1996 to December 2006, 7342 cases of gastric cancer patients were treated in the Fourth Hospital of Hebei Medical University, including 87 cases of gastric stump cancer(GSC), 124 cases of Recurrent gastric stump cancer. Through collected the clinical information of GSC and Recurrent gastric stump cancer's patients, to study the situation of the initial surgery, the treatment conditions, auxiliary examination, the tumor biological behavior, treatment and prognosis. The size of the percentage rate of the various statistical indicators was analyzed, the various indicators were analyzed by using SPSS 13.0 statistical package, the statistical methods were tested byχ~2, the data was statistically analyzed byα=0.05. The data was grouped according to treatment, pathological stage, whether the combined organ resection, and the survival curves of each group was drawn by Kaplan-Meier, The differences which is survival rate of the groups was compared using the Log-rank.Results:1 75 male patients, 12 female patients with GSC, male: female was 6.3:1. 104 male patients, 20 female patients with Recurrent gastric stump cancer, male: female was 5.2:1. The mean interval time was 28.7±7.4 years for the initial surgery to GSC, The mean interval time was 3.7±1.5 years for the initial surgery to Recurrent gastric stump cancer.2 GSC, The proportion of tumor involvement anastomosis was 5.3%( 3/57 ) , Recurrent gastric stump cancer, The proportion of tumor involvement anastomosis was 44.9%(31/69), the difference was significant (P<0.05).3 The lymph node metastasis rate of GSC was 48.1%(217/451), The lymph node metastasis rate of recurrent gastric stump cancer was 38.7%(109/282), the difference was significant (P<0.05). GSC patients, lymph node metastasis rate was 55.8% (24/43), Recurrent gastric stump cancer patients, lymph node metastasis rate was 33.3% (13/39), the difference was significant (P<0.05).4 The resection rate of GSC was 84.2%(48/57), The resection rate of recurrent gastric stump cancer was 68.1%(47/69), the difference was significant (P<0.05). The curative resection rate of GSC was 75.4%(43/57), The curative resection rate of recurrent gastric stump cancer was 56.5%(39/69), the difference was significant (P<0.05).5 GSC, the curative resection rate of BillrothⅠtype for first surgical was 71.4%(15/21), the curative resection rate of BillrothⅡtype for first surgical was 75.9%(22/29), the curative resection rate of Esophagus-stomach anastomosis for first surgical was 85.7%(6/7), the difference was not significant (P>0.05). Recurrent gastric stump cancer, the curative resection rate of BillrothⅠtype for first surgical was 33.3%(6/18), the curative resection rate of BillrothⅡtype for first surgical was 69.7%(23/33), the difference was significant (P<0.0125).6 The combined organ resection rate of GSC was 18.8%(9/48), The combined organ resection rate of recurrent gastric stump cancer was 38.3%(18/47), the difference was significant (P<0.05).7 The postoperative complication rate of combined organ resection of GSC was 33.3%(3/9), the postoperative complication rate of without combined organ resection was 4.2%(2/48), the difference was significant (P<0.05). The postoperative complication rate of combined organ resection of recurrent gastric stump cancer was 33.3% ( 6/18 ) , the postoperative complication rate of without combined organ resection was 9.8%(5/51), the difference was significant (P<0.05).8 Radical resection, palliative resection, short-circuit operation, pure exploration, non-surgical treatment of GSC, the median survival was 33 months, 18 months, 9 months, 5 months and 5 months, the difference was significant (P<0.05). the survival of radical resection was longer than palliative resection's, the difference was significant (P<0.05). the survival of palliative resection was longer than short-circuit operation's, the difference was significant (P<0.05). Radical resection, palliative resection, short-circuit operation, pure exploration, non-surgical treatment of recurrent gastric stump cancer, the median survival was 31 months, 15 months, 7 months, 6 months and 5 months, the difference was significant (P<0.05). the survival of radical resection was longer than palliative resection's, the difference was significant (P<0.05). the survival of palliative resection was longer than short-circuit operation's, the difference was significant (P<0.05).9 TheⅠ,Ⅱ,Ⅲ,Ⅳstage of GSC'patients, the median survival was 95 months, 48 months, 29 months, 9 months, the difference was significant (P<0.05). the difference ofⅠ,Ⅱwas not significant (P>0.05); the survival ofⅠ,Ⅱstage was longer thanⅢstage's, the difference was significant (P<0.05); the survival ofⅢstage was longer thanⅣstage's, the difference was significant (P<0.05).TheⅠ,Ⅱ,Ⅲ,Ⅳstage of recurrent gastric stump cancer'patients, the median survival was 56 months, 39 months, 24 months, 8 months, the difference was significant (P<0.05). the difference ofⅠ,Ⅱwas not significant (P>0.05); the survival ofⅠ,Ⅱs tage was longer thanⅢstage's, the difference was significant (P<0.05); the survival ofⅢstage was longer thanⅣstage's, the difference was significant (P<0.05).10 The median survival of the combined organ resection of GSC was 33 months, the median survival of without combined organ resection was 21 months, the difference was not statistically significant (P>0.05). The median survival of the combined organ resection of recurrent gastric stump cancer was 24 months, the median survival of without combined organ resection was 11 months, the difference was not statistically significant (P>0.05).Conclusion:1 GSC male: female was 6.3:1, Recurrent gastric stump cancer male: female was 5.2:1, GSC and Recurrent gastric stump cancer are more occurred in male patients.2 The mean interval time was 28.7±7.4 years for the initial surgery to GSC, The mean interval time was 3.7±1.5 years for the initial surgery to Recurrent gastric stump cancer, the interval time is short for the initial surgery to Recurrent gastric stump cancer.3 GSC, The proportion of tumor involvement anastomosis was 5.3%, Recurrent gastric stump cancer, The proportion of tumor involvement anastomosis was 44.9%, Recurrent gastric stump cancer compared with GSC, tumor is mainly in the anastomosis.4 The lymph node metastasis rate of GSC is higher than recurrent gastric stump cancer's.5 The resection rate of GSC was 84.2%, the curative resection rate was 75.4%; The resection rate of recurrent gastric stump cancer was 68.1%, the curative resection rate was 56.5%, the resection rate, curative resection rate of GSC are higher than recurrent gastric stump cancer's.6 The first operation of different type of GSC, radical resection rate are not significant difference; Recurrent gastric stump cancer, the curative resection rate of BillrothⅡtype for first surgical is higher than BillrothⅠtype's.7 The combined organ resection rate of GSC was 18.8%, The combined organ resection rate of recurrent gastric stump cancer was 38.3%, the combined organ resection rate of recurrent gastric stump cancer is higher than GSC's. 8 The postoperative complication rate of combined organ resection is higher than without combined organ resection's in GSC and recurrent gastric stump cancer.9 GSC and Recurrent gastric stump cancer underwent radical resection, the median survival was 33 months and 31 months, compared with other treatment modalities, both of them are better prognosis after radical resection.10 The GSC and Recurrent gastric stump cancer are better prognosis ofⅠ,Ⅱstages.11 The survival time is not significantly prolongs after combined organ resection in GSC and recurrent gastric stump cancer.