The Biological Behavior And Surgical Treatment Of Advanced Gastric Carcinoma (Clinical Analysis Of 6899 Cases)

Objective: In this paper, we will analyze and discuss biological features and the surgical treatment of advanced gastric cancer, in order to justify for normalizing the treatment, improving the curative effect and lifeline.Methods: During 1996-2006, there were 6899 advanced gastric cancer patients in our hospital. We collected each medical record and described or analysed the factors, such as pathogenesis, symptom, complication, sign, auxiliary examination, tumor position, size, gross classification, pathology typeset, histomorphological types, infiltration depth, residual end, pTNM, surgery properties, kind of surgery, gastrointestinal reconstruction, complication after operation. The data was watched, described, statisticsed by SPSS13.0, P<0.05 is meaningful. After statistics and analysis, we studied the biological behavior and surgical treatment of advanced gastric carcinoma.Results:1 Pathogenesis: There were 6899 advanced gastric cancer patients in our hospital, and 5496 patients had been operated, the operability was 78.7%, relative number of males and females in a population was 3.50: 1, the average age of advanced gastric carcinoma was 58.83±10.07 years(14-90years). There were 10.8% patients had family history, and 34.0% patients had Smoking history, 19.6% patients had drinking history.1.1 The number of advanced gastric cancer patients from 1996 to 2006 were 353, 403, 344, 340, 283, 487, 616, 646, 668, 709, 647cases; the average age of advanced gastric cancer patients from 1996 to 2006 were (57.60±8.67),(57.11±9.80),(57.05±9.93),(58.43±10.32),(57.96±11.33),(58.30±9.47),(58.67±10.35),(59.70±10.12),(59.45±10.34),(59.87±10.05),(59.98±9.81) years.2 Symptom, sign, diagnosis 2.1 Symptom: There were 25.9% patients whose symptom was eating discomfort, and from most to least is bellyache (22.9%), abdominal distension (15.1%),emaciation (11.8%), vomit (8.4%), melena (7.8%), nausea (5.4%), hematemesis (1.6%). There were 15.8% patients whose symptom was haemorrhage, and from most to least was pylorochesis (6.2%), perforate (0.5%).In the patients whose tumor position is pylorus, there were 42.3% patients whose symptom was pylorochesis in patients.2.2 Sign: There were 19.2% patients whose sign was abdomianldistention, and from most to least was alpable mass(22.9%), sign of ascites (4.5%), Virchow lymph node metastasis (0.7%), nus check (8.4%). ena(7.8%), nausea (5.4%), hematemesis(1.6%), virchow lymph node metastasis (11.8%), anus heck(0.4%).And there were 71.7% patients who had no sign.2.3 Diagnosis: The diagnosis of gastroscope and pathology was 97.7%; The detection rate of X-rays was 87.4%. The detection rate of CT for gastric carcinoma was 95.1%, and for hepatic metastases was 92.9%, for lymphadenovarix was 28.3%. The detection rate of B ultrasound for gastric carcinoma was 86.2%, and for hepatic metastases was 60.6%, for lymphadenovarix was 22.3%.3 Pathology typeset3.1 Tumor position: There was 67.1% patients whose tumor position was upper stomach, 11.3% patients whose tumor position was stomach central, 11.3% patients whose tumor position was lower stomach. There were 0.7% patients whose tumor position is multicentric.3.2 Size: There were 25.9% patients whose diameter was <5cm, and there were 74.1% patients whose diameter was≥5cm.3.3 Gross classification: There were 2.1% patients were BorrmannⅠ, 36.8% patients areⅡ, 54.7% patients were BorrmannⅢ, 5.5% patients were BorrmannⅣ, 0.9% patients were BorrmanⅤ.3.4 Histomorphological types: There were 51.4% patients whose histomorphological types was modcrate, 48.6% patients whose histomorphological types is poor. 3.5 Infiltration depth: There were 9.5% patients whose tumour infiltrates muscular layer, 10.4% patients whose tumour infiltrates serosa, 80.1% patients whose tumour penetrates serosa.3.6 Lymph node metastasis: There were 66.7% patients who has lymph node metastasis.3.7 Penetration and tissues and organs: There were 6.9% patients whose tumour infiltrates adjacent tissues, 3.5% patients whose tumour infiltrates distant organs. There were 10.3% patients who had LVSI, 4.5% patients whose nerve was invade.3.8 Residual end: There were 5.9% patients whose residual end on was positive, 5.7% patients whose residual end under was positive.3.9 pTNM:There were 4.4% patients wereⅠtype, 29.8% patients wereⅡtype, 62.3% patients wereⅢtype, 3.5% patients wereⅣtype. 3.10 The relationship between age and tumor positionThe average age of advanced gastric carcinoma patients whose tumor position was antrum was 56.83±11.16 years, the average age of advanced gastric carcinoma patients whose tumor position was corpusventriculi was 56.57±11.11 years, the average age of advanced gastric carcinoma patients whose tumor position was cardia was 59.94±9.50 years.3.11 The relation between lymph node metastasis and some biologic characteristic3.11.1 There were 69.6% female patients has lymph node metastasis, 65.8% male patients has lymph node metastasis(P=0.022).3.11.2 There were 54.8% patients whose diameter was <5cm has lymph node metastasis, 71.6% patients whose diameter was≥5cm has lymph node metastasis(P=0.000).3.11.3 There were 65.0% patients who was BorrmannⅠ,Ⅱhas lymph node metastasis, 68% patients who was BorrmannⅢ,Ⅳhad lymph node metastasis(P=0.035).3.11.4 There were 43.3% patients whose tumour infiltrates muscular layer had lymph node metastasis, 69.0% patients whose tumour penetrates muscular layer had lymph node metastasis(P=0.035).3.12 Lymph node metastasis of different siteThe lymph node metastasis of antrum gastric cancer was 74.3%, body gastric cancer was 72.5%, cardia cancer was 68.5%. And in each part of the lymph node metastasis were 1, 2 station, the third station had different degree of transfer. In various parts of the third group stomach amazon lymph node metastasis rate: distal gastric cancer for 46.3%, the others all in more than 50 percent.4 Operation status4.1 Property of operation: There were 78.7% patients who was radical operated, 19.0% patients who was palliative operated, 1.1% patients who was operated by gastroenterostomy, 3.2% patients who was operated by only laparotomy.4.2 Kind of surgery: There were 36.7% patients whose tumor position was upper stomach was operated through thoracotomy, 29.7% patients whose tumor position was upper stomach was operated through laparotomy, 17.3% patients who was operated by distal stomach most resection, 11.9% patients who was operated by total gastrectomy, 4.3%% patients who was operated by other ways. There were 5.1% patients who was operated of multi-visceral. There were no obvious change of patients who was operated by only laparotomy, and the number of patients who was operated by total gastrectomy was rising with the number of the patients.4.3 Gastrointestinal reconstruction: There were 58.0% patients who was operated by residual stomach esophagus anastomosis, 13.9% patients who was operated by esophagojejunostomy, 6.0% patients who was operated by BillrothⅠ, 12.1% patients who was operated by BillrothⅡ, 10.0% patients who is operated by jejunal interposition.4.4 Complication after operation: There were 9.3% patients who has complications. There were 21.1% patients who had complications of respiratory system, 17.9% patients who had complications of incision, 25.6% patients who had complications of obstruction, 12.3% patients who had complications of fistula, 13.8% patients who had complications of haemorrhage, 2.9% patients who had complications of vessel, 3.0% patients who had complications of abdominal infection, 3.4% patients who had others complications.4.5 Contrast with through thoracotomy and through laparotomy of operation of cardiac carcinomaThere were 4.7% patients whose residual end on was positive through thoracotomy of operation of cardiac carcinoma, 6.9% patients whose residual end on was positive through laparotomy of operation of cardiac carcinoma(P=0.011).There were 7.1% patients whose residual end under was positive through thoracotomy of operation of cardiac carcinoma,there were 1.7% patients whose residual end under was positive through laparotomy of operation of cardiac carcinoma(P=0.000).There were 8.5% patients who had complication through thoracotomy of operation of cardiac carcinoma, 4.3% patients who had complication through laparotomy of operation of cardiac carcinoma(P=0.000). The positive rate of lymph node dissection through thoracotomy of operation of cardiac carcinoma was 61.2%, and through laparotomy of operation of cardiac carcinoma was 68.5%(P=0.000). The positive rate of lymph node dissection in the seventh group through thoracotomy of operation of cardiac carcinoma was 54.8%, and through laparotomy of operation of cardiac carcinoma was 59.6%(P=0.032). The positive rate of lymph node dissection in the first group through thoracotomy of operation of cardiac carcinoma was 50.2%, and through laparotomy of operation of cardiac carcinoma was 55.6% (P=0.044). The positive rate of lymph node dissection in the second group through thoracotomy of operation of cardiac carcinoma was 48%, and through laparotomy of operation of cardiac carcinoma was 50%(P=0.685). The positive rate of lymph node dissection in the third group through thoracotomy of operation of cardiac carcinoma was 57.8%, and through laparotomy of operation of cardiac carcinoma was 58.2%(P=0.897).Conclusion: 1 Most of advanced gastric carcinoma were old people, and male patients. There were 10.8% patients had family history, and 34.0% patients had Smoking history, 19.6% patients had drinking histories. The average age of advanced gastric cancer patients was increasing.2 The symptom of advanced gastric cancer patients was eating discomfort, bellyache, abdominal distension, emaciation, vomit, melena, nausea, hematemesis. There were 15.8% patients whose symptom is haemorrhage, and from most to least was pylorochesis (6.2%), perforate (0.5%).And there were 6.2% patients whose symptom was pylorochesis in patients whose tumor position was pylorus. And there were 71.7% patients whose sign was nothing.3 The diagnosis of gastroscope and pathology was 97.7%; the detection rate of X-rays was 87.4%, CT for gastric carcinoma was 95.1%, B ultrasound for gastric carcinoma was 86.2%. The detection rate of CT for hepatic metastases and lymphadenovarix was more than that of B ultrasound.4 There were 67.1% patients whose tumor position was upper stomach, 11.3% was stomach central, 11.3% is stomach lower, and 0.7% was multicentric. The average age of advanced gastric cancer patients was increasing with the rising of tumor position. There were 25.9% patients whose diameter was <5cm, and 74.1% was≥5cm. There were 2.1% patients were BorrmannⅠ, 36.8% wereⅡ, 54.7% were BorrmannⅢ, 5.5% were BorrmannⅣ, 0.9% were BorrmanⅤ.5 There were 51.4% patients whose histomorphological types was modcrate, 48.6% was poor. There were 9.5% patients whose tumour infiltrates muscular layer, 10.4% infiltrates serosa, 80.1% penetrates serosa. There were 6.9% patients whose tumour infiltrates adjacent tissues, 3.5% infiltrates distant organs. There were 10.3% patients who had LVSI, 4.5% nerve was invade.6 There were 66.7% patients who had lymph node metastasis. The lymph node metastasis rate of female patients was more than male patients. The lymph node metastasis rate of patients whose diameter was≥5cm was more than that of <5cm. The lymph node metastasis rate of patients who was BorrmannⅢ,Ⅳwas more than that of BorrmannⅠ,Ⅱ. The lymph node metastasis rate of patients whose tumour penetrates muscular layer was more than that of patients whose tumour infiltrates muscular layer. The lymph node metastasis of antrum gastric cancer was 74.3%, body gastric cancer was 72.5%, cardia cancer was 68.5%. In various parts of the third group stomach amazon lymph node metastasis rate: distal gastric cancer for 46.3%, the others all in more than 50 percent.7 There were 5.9% patients whose residual end on was positive, there were 5.7% patients whose residual end under was positive. There were 4.4% patients wereⅠtype, 29.8% wereⅡtype, 62.3% wereⅢtype, 3.5% wereⅣtype.8 There were 78.7% patients who were radical operated, 19.0% was palliative operated, 1.1% was operated by gastroenterostomy, 3.2% was operated by only laparotomy. There were 36.7% patients whose tumor position was upper stomach was operated through thoracotomy, 29.7% through laparotomy, 17.3% by distal stomach most resection, 11.9% by total gastrectomy, 4.3% was operated by other ways. There were 5.1% patients who were operated of multi-visceral. There were no obvious change of patients who was operated by only laparotomy, and the number of patients who was operated by total gastrectomy was rising with the number of the patients.9 There were 58.0% patients who were operated by residual stomach esophagus anastomosis, 13.9% by esophagojejunostomy, 6.0% by BillrothⅠ, 12.1% by BillrothⅡ, 10.1% by jejunal interposition. There were 9.3% patients who hadcomplications.10 The positive rate of residual end on of patients who is through thoracotomy of operation of cardiac carcinoma is less than through laparotomy. The positive rate of residual end under of patients who was through thoracotomy of operation of cardiac carcinoma was more than through laparotomy. The positive rate of complications of patients who was through thoracotomy of operation of cardiac carcinoma was more than through laparotomy. The positive rate of lymph node dissection through thoracotomy of operation of cardiac carcinoma was less than that through laparotomy in total, the first group, the seventh groups.