| BackgroundGastric cancer has been known to us. According to statistics, the new gastriccancer worldwide each year up to90million, an average of about70million peopledied of stomach cancer each year. According to the article called "World Journal ofGastroenterology" published by Dr. Yang Ling who works in National CancerPrevention and Control Office. In2005, China reached37.1/100thousand incidenceof gastric cancer in men, women as17.4/100thousand. In our country, annualnew-onset patients with gastric cancer by up to40million people, the death tollreached30million people. Stomach cancer is the third most common cancer in China(in men behind lung cancer and liver cancer, women behind lung cancer and breastcancer). With the development of medical standards and the improvement of people’sliving standards, increase people’s awareness of gastric cancer, the overall incidenceand mortality of gastric cancer has decreased, but the trend is to decrease caused bymen, on the contrary, women’s gastric cancer incidence and mortality there is a risingtrend, and tends to be more younger.In addition to large-scale population screening inJapan, the treatment of most patients, the tumor is already in progress or late stage,tumor stage will undoubtedly affect the patient’s prognosis and survival time.According to more than twenty years of global data, it confirm that for advancedgastric cancer, even if we expand tumor resection with lymph node dissection,5-year survival rate of patients with essential fluctuated around40%, while in theimplementation of early gastric cancer after radical resection,5-year survival rate ofup to85%.So, early screening for gastric cancer patients, not only can improve thedetection rate of gastric cancer, but also reduces the difficulty of treatment on patientswith gastric cancer. Since the German surgeon Schlatter first successfulimplementation of a total gastrectomy in gastric cancer treatment in1857.The totalgastrectomy (TG)has been widely used in the treatment of gastric cancer, Even somescholars regard it as a routine surgical gastric cancer in the late1940s to the early1950s，and the treatment guidelines in Japan in2010will total gastrectomy as thestandard surgical approach cardia. However, total gastrectomy, continuity andintegrity of the patient’s digestive tract is damaged, it lost the stomach for storage,mixing of food and digestive secretion, affecting food intake and digestion andabsorption. So there will be a number of postoperative complications, thesepostoperative complications seriously affect the quality of life of patients aftersurgery. With the growing level of medical technology, in the case of guaranteetumor cure for gastric cardia, and some scholars believe that the proximal part of thestomach to retain viable gastrectomy(PG), it will not only ensure the continuity of thenormal digestive tract, and gastric remnant stomach can bear some functions,according to the Extensive clinical data show that the proximal gastric cardiaunderwent radical gastrectomy, patients with reflux esophagitis and gastritis heavierresidue, also affect the quality of life of patients after surgery, and the tumorrecurrence rate is relatively high. Therefore, for patients with gastric cardia, how toimplement a more rational surgical approach will be a hot research of cardia.PurposeThe purpose of this paper is to by comparing radical proximal gastrectomy withradical total gastrectomy difference between the two surgical methods in thetreatment of gastric cardia, and complications, nutritional status, recurrence rate andpostoperative survival time of patients impact, thereby providing a basis for clinicaltreatment options cardia surgical approach is reasonable, so that the maximum benefit of patients during treatment.MethodsRetrospective analysis of clinical data2003-2006Henan Tumor Hospitalinpatient revenue300cases of cardiac patients,151underwent radical gastrectomy,149underwent radical proximal gastrectomy, total gastrectomy group divided andproximal gastrectomy group. Total gastrectomy group of digestive tractreconstruction are used esophagus jejunal Roux-en-Y anastomosis, proximalgastrectomy group with esophageal remnant stomach wall directly anastomosis, andpostoperative follow-up of300cases of recovery status, postoperative disease,nutritional status, recurrence, t test and χ2test differences between two groups werecompared statistically, using life-table method of survival analysis of two groups ofpatients, the survival rate is calculated and the median survival time, while usingLog-rank test to compare differences in survival between the two groups of patients.Results①The mean operative time of the total gastrectomy is3.06h, and the meanoperative time of proximal gastrectomy is3.02h.These two sets of data is notstatistically significant difference (P>0.05), namely radical total gastrectomy withradical proximal gastrectomy want to compare the time spent in both the surgicalprocedure is basically the same ease of operation similar to the operation.②The average amount of bleeding is155.30ml, and the proximal gastrectomyis151.01ml. These two groups of data is not statistically significance (P>0.05),namely radical total gastrectomy with radical proximal gastrectomy compared to thesame time after the average amount of bleeding, that is to say, these two surgicalapproach is basically the same traumatic stimuli.③The average discharge time of the total gastrectomy is3.68days, and theaverage discharge time of proximal gastrectomy is3.91days. These two groups ofdata is not statistically significance (P>0.05), namely radical total gastrectomy withradical proximal gastrectomy compared to the same time after the discharge, the impact of two surgical patients bowel function basically the same.④About the total gastrectomy, the six days of average tube drainage are90.77ml,91.68ml,90.97ml,86.51ml,72.25ml,70.84ml; proximal gastrectomy sixdays of average tube drainage92.62ml,93.22ml,95.87ml,125.23ml,96.72ml,89.73ml, two sets of data were compared with the results of the first postoperativeday1,2, gastric drainage whole stomach gastric drainage group and the group ofproximal stomach difference between not statistically significant (P>0.05);postoperative day4,5,6, gastric drainage whole group closer to the end of the stomachless stomach group, two sets of data were statistically significant differences (P<0.05).⑤About the total gastrectomy，the first, third, fifth, eighth average volume ofalbumin were34.67g/L,31.72g/L,29.71g/L,28.58g/L; And the proximalstomach group the first, third, fifth, eighth average volume of albumin were onaverage albumin34.89g/L,31.85g/L,9.89g/L,28.89g/L, two sets of datacompared to the amount of albumin group after full stomach and proximal stomachalbumin group basically the same, that is, the difference was not statisticallysignificant (P>0.05), but whether it is the whole group or proximal gastric stomachgroup, over time, the amount of albumin in patients with postoperative descendingorder.⑥The detection rate of5,6lymphadenectomy group of the total gastrectomygroup were81.46%and69.54%,5,6proximal gastrectomy group lymphadenectomyrates were63.76%and58.39%, compared with two sets of data, the differencestatistically significant (P <0.05), ie, radical gastrectomy, the higher the rate of5,6lymphadenectomy group.⑦About the total gastrectomy group, in the perioperative, the postoperativecomplications of wound infection were9cases (5.96%), anastomotic fistula in onecase (0.66%), anastomotic stenosis in3cases (0.66%), abdominal infection17cases(11.26%), chylous leakage3patients (1.99%), intestinal obstruction two cases(1.32%), while the proximal stomach wound infection group11patients (7.38%),anastomotic fistula in3cases (2.01%), anastomotic stricture4cases (2.68%),stomach paralysis3cases (2.01%), abdominal infection in14patients (9.40%), chylous leak one case (0.67%), intestinal obstruction one case (0.67%), two sets ofdata, the difference was not statistically significant (P>0.05), ie, whether it is radicalgastrectomy or proximal gastrectomy line, produced no effect on postoperativecomplications recently.⑧In the one year after surgery complications, postoperative whole stomach acidreflux and heartburn occurred in23cases (15.23%), anastomotic severe inflammationin11patients (7.28%), dumping syndrome,7cases (4.64%); proximal stomach grouppostoperative reflux esophagitis41cases (27.52%), anastomotic severe inflammationin28cases (18.79%), dumping syndrome,4cases (2.68%); two sets of data werecompared, results suggest that reflux esophagitis the probability of occurrence ofanastomotic inflammation and severe inflammation, the difference was statisticallysignificant (P <0.05), ie, radical total gastrectomy low probability of occurrence ofreflux esophagitis and severe inflammation of the match, while radical proximal morepatients after gastrectomy gastric reflux, severe inflammation; in the rate ofpostoperative dumping syndrome, the difference was not statistically significant (P>0.05), ie, the total gastrectomy and the proximal gastrectomy postoperative dumpingsyndrome cases are the same.⑨In the assessment of nutritional status on postoperative scores, totalgastrectomy group MNA <17in9patients (5.96%),17≤MNA <24of113patients(74.83%), MNA≥29patients24(19.21%); total gastrectomy group, the averageMNA21.05; proximal gastrectomy group MNA <17of25patients (16.78%),17≤MNA <24patients with97cases (65.10%), MNA≥24that malnourished patientswith resection of the stomach full sets of data compared to the results of the MNAgroup <17, the difference was statistically significant (P <0.05); in27patients(18.12%), with an average of18.87MNA smaller proportion;≤MNA <24group, thedifference was statistically significant (P <0.05) in17patients with malnutrition riskthat total gastrectomy group higher proportion; while MNA≥there was no differencebetween the24patients (P>0.05), that there is no difference between the two surgicalpostoperative patients under nourished; MNA scoring average, the two sets of datawere statistically significant differences (P <0.05), and the total gastrectomy groupMNA higher average scores. ⑩The total gastrectomy patients relapsed42cases (27.81%), the proximalgastrectomy group relapsed56cases (37.58%), two sets of data, the difference wasstatistically significant (P <0.05), ie, total gastrectomy group with proximalgastrectomy group compared to the higher recurrence rate of proximal gastrectomysurgery group.The3-year survival rate of total gastrectomy group was50%of patients,5-year survival rate was40%, the median survival time was39.06months; In theproximal gastrectomy,the3-year survival rate was47%, and5-year survival rate was21%, with a median survival time was33.40months, with the Log-rank test for thewhole group and the proximal stomach stomach groups was not statisticallysignificant (P>0.05) between the3-year survival difference between the5-yearsurvival difference was statistically significant (P <0.05), total gastrectomy group of5-year survival rate was significantly higher than the proximal stomach.Conclusion①The total gastrectomy and the proximal gastrectomy, the degree ofcomplexity of the surgery, such as postoperative recovery of intestinal function andthe degree of the recent incidence of complications is basically the same, in thecourse of postoperative recovery may appear hypoalbuminemia②The proximal gastrectomy group were more tube drainage, and proximalgastrectomy reflux conditions and consistent with severe inflammation, often needthe support of a proton pump inhibitor therapy, the impact of patients with eating;while total gastrectomy Roux-en-Y anastomosis to be effective in preventing refluxand the incidence of severe inflammation fit, long-term nutritional status than thoseproximal gastrectomy esophageal anastomosis remnant stomach wall.③The radical gastrectomy for NO.5, NO.6lymph nodes, has a high removalrate, recurrence rate close to the low end gastrectomy surgery, and postoperative5-year survival and median survival time was higher than in recent end gastrectomy. |
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