Research on Lymph Node Metastases of Gastric Stump Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DENG Hongqiang , WU Honggen , LIU Chao

Department of General Surgery-Pediatric Surgery， People’s Hospital of Guangxi Zhuang Autonomous Region， Nanning 530021， Guangxi， China;

Corresponding author：

DENG Hongqiang, Email: chunliulu@163.com

Keywords：

Gastric stump cancer; Lymph node; Metastasis

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Objective 　To study the features of lymph node metastasis in gastric stump cancer （GSC） in order to provide the basis for the reasonable lymph node dissection in the GSC lymphadenectomy.
Methods 　Twenty-two GSC patients accepted residual radical gastrectomy and 50 primary gastric cancer patients accepted distal D2 lymphadenectomy by the same surgeon from June 2004 to June 2012 at the department of general surgery-pediatric surgery of the People’s Hospital of Guangxi Zhuang Autonomous Region were included in this retrospective study. And the clinicopathologic factors and lymph node metastasis were compared in two groups.
Results 　The combined organ resection rate in the primary gastric cancer patients was significantly lower than that in the GSC patients 〔14.00% （7/50） versus 54.55% （12/22），χ2=12.929，P=0.000〕. In the lymph node metastasis，the total positive rate and No.10 positive rate of lymph node metastasis in the GSC patients were significantly higher than those in the primary gastric cancer patients 〔30.56% （103/337） versus 22.13% （208/940），χ2=9.583，P=0.002；52.17% （12/23） versus 17.39% （4/23），χ2=6.133，P=0.013〕. The positive rate of lympl node micrometastasis between the GSC patients and primary gastric cancer patients was no significant difference〔2.97% （10/337） versus 1.49% （14/940），χ2=2.939，P=0.086〕 . There was 4/12 lymph node micrometastasis in the GSC patients，which was 0/4 in the primary gastric cancer patients. The positive rate of the jejunal mesentery lymph node metastasis was 35.71% （5/14） in the GSC patients.
Conclusions 　GSC has a unique pattern in lymph node metastasis. D2 dissection and jejunsl mesentery lymph node dissection should be performed for these patients，especially，on No.10 lymph nodes. If needed，en bloc resection with invaded adjacent organs should be considered．

Citation： DENG Hongqiang,WU Honggen,LIU Chao,.. Research on Lymph Node Metastases of Gastric Stump Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(5): 536-539. doi: Copy

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2.	Rabin I， Kapiev A， Chikman B， et al. Comparative study of the pathological characteristics of gastric stump carcinoma and carci-noma of the upper third of the stomach[J]. Isr Med Assoc J， 2011， 13(9)：534-536.
3.	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.
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8.	Komatsu S， Ichikawa D， Okamoto K， et al. Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy[J]. World J Gastroenterol， 2012， 18(22)：2832-2836.
9.	Lee IJ， Lee JM， Kim SH， et al. Helical CT evaluation of the preoperative staging of gastric cancer in the remnant stomach[J]. AJR Am J Roentgenol， 2009， 192(4)：902-908.
10.	Kunisaki C， Shimada H， Nomura M， et al. Lymph node dissection in surgical treatment for remnant stomach cancer[J]. Hepatogastroenterology， 2002， 49(44)：580-584.
11.	宋武，何裕隆，蔡世荣，等. 残胃癌的临床病理特点及淋巴结转移规律分析[J]. 中华外科杂志， 2009， 47(24)：1860-1863.
12.	Mochiki E， Kamiyama Y， Aihara R， et al. Postoperative functional evaluation of jejunal interposition with or without a pouch after a total gastrectomy for gastric cancer[J]. Am J Surg， 2004， 187(6)：728-735.
13.	Han SL， Hua YW， Wang CH， et al. Metastatic pattern of lymph node and surgery for gastric stump cancer[J]. J Surg Oncol， 2003， 82(4)：241-246.

1. Lee SB， Kim JH， Kim DH， et al. Clinicopathological characteristics and prognosis of remnant gastric cancer[J]. J Gastric Cancer， 2010， 10(4)：219-225.
2. Rabin I， Kapiev A， Chikman B， et al. Comparative study of the pathological characteristics of gastric stump carcinoma and carci-noma of the upper third of the stomach[J]. Isr Med Assoc J， 2011， 13(9)：534-536.
3. 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.
4. 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.
5. 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.
6. 日本胃癌研究会. 胃癌取り报い规约[M]. 第13版. 东京：金原出版社， 1999：6.
7. Khushalani N. Cancer of the esophagus and stomach[J]. Mayo Clin Proc， 2008， 83(6)：712-722.
8. Komatsu S， Ichikawa D， Okamoto K， et al. Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy[J]. World J Gastroenterol， 2012， 18(22)：2832-2836.
9. Lee IJ， Lee JM， Kim SH， et al. Helical CT evaluation of the preoperative staging of gastric cancer in the remnant stomach[J]. AJR Am J Roentgenol， 2009， 192(4)：902-908.
10. Kunisaki C， Shimada H， Nomura M， et al. Lymph node dissection in surgical treatment for remnant stomach cancer[J]. Hepatogastroenterology， 2002， 49(44)：580-584.
11. 宋武，何裕隆，蔡世荣，等. 残胃癌的临床病理特点及淋巴结转移规律分析[J]. 中华外科杂志， 2009， 47(24)：1860-1863.
12. Mochiki E， Kamiyama Y， Aihara R， et al. Postoperative functional evaluation of jejunal interposition with or without a pouch after a total gastrectomy for gastric cancer[J]. Am J Surg， 2004， 187(6)：728-735.
13. Han SL， Hua YW， Wang CH， et al. Metastatic pattern of lymph node and surgery for gastric stump cancer[J]. J Surg Oncol， 2003， 82(4)：241-246.

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