Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions?
Adenocarcinoma
/ etiology
Aged
Anastomosis, Surgical
/ adverse effects
Female
Gastrectomy
/ adverse effects
Gastric Stump
/ pathology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Postoperative Complications
/ etiology
Prognosis
Reoperation
/ methods
Stomach Neoplasms
/ mortality
Survival Rate
Treatment Outcome
Anastomotic site
Gastric stump cancer
Subtotal gastrectomy
Total gastrectomy
Journal
World journal of surgical oncology
ISSN: 1477-7819
Titre abrégé: World J Surg Oncol
Pays: England
ID NLM: 101170544
Informations de publication
Date de publication:
27 Feb 2020
27 Feb 2020
Historique:
received:
15
10
2019
accepted:
18
02
2020
entrez:
29
2
2020
pubmed:
29
2
2020
medline:
25
11
2020
Statut:
epublish
Résumé
Total gastrectomy (TG) is a widely accepted procedure for treating gastric stump cancer (GSC). However, subtotal gastrectomy (SG) would benefit elective patients with GSC. The aim of this study was to clarify the safety and long-term prognosis of SG in treating GSC after distal gastrectomy for benign lesions. A total of 53 patients with GSC located at the anastomotic site or gastric body between May 1999 and December 2018 at our hospital were included. In total, 21 patients underwent SG, and the remaining 24 patients underwent TG. Clinicopathological data, operative data, and overall survival (OS) were compared. The operative duration, estimated blood loss volume, and length of hospital stay were similar between the SG and TG groups. The postoperative complications were similar between the two groups, but no cases of anastomotic leakage were noted in the SG group. TG was associated with significantly more retrieved lymph nodes than SG (18.5 ± 11.5 vs. 10.7 ± 9.2; p = 0.017), while the number of metastatic lymph nodes did not differ between the groups (2.9 ± 3.5 vs. 1.9 ± 3.6; p = 0.329). The median survival time in the SG group was 81.0 months (95% confidence interval (CI), 68.906 to 93.094 months), which was similar to the 45.0 months (95% CI, 15.920 to 74.080 months) observed in the TG group (p = 0.236). Both univariate and multivariate analyses showed that tumor location and histological type were prognostic factors, while surgery type was not a prognostic factor. Further stratified analyses according to tumor location revealed that OS was not significantly different between the two groups among patients with tumors located at the anastomotic site, while OS in the TG group was significantly better than that in the SG group among patients with tumors located in the gastric body (p = 0.046). The results of the current study indicate that SG is a suitable alternative surgical procedure for GSC located at the anastomotic site after distal gastrectomy for benign lesions. The short-term outcomes and long-term prognoses of SG are comparable with those of TG.
Sections du résumé
BACKGROUND
BACKGROUND
Total gastrectomy (TG) is a widely accepted procedure for treating gastric stump cancer (GSC). However, subtotal gastrectomy (SG) would benefit elective patients with GSC. The aim of this study was to clarify the safety and long-term prognosis of SG in treating GSC after distal gastrectomy for benign lesions.
METHODS
METHODS
A total of 53 patients with GSC located at the anastomotic site or gastric body between May 1999 and December 2018 at our hospital were included. In total, 21 patients underwent SG, and the remaining 24 patients underwent TG. Clinicopathological data, operative data, and overall survival (OS) were compared.
RESULTS
RESULTS
The operative duration, estimated blood loss volume, and length of hospital stay were similar between the SG and TG groups. The postoperative complications were similar between the two groups, but no cases of anastomotic leakage were noted in the SG group. TG was associated with significantly more retrieved lymph nodes than SG (18.5 ± 11.5 vs. 10.7 ± 9.2; p = 0.017), while the number of metastatic lymph nodes did not differ between the groups (2.9 ± 3.5 vs. 1.9 ± 3.6; p = 0.329). The median survival time in the SG group was 81.0 months (95% confidence interval (CI), 68.906 to 93.094 months), which was similar to the 45.0 months (95% CI, 15.920 to 74.080 months) observed in the TG group (p = 0.236). Both univariate and multivariate analyses showed that tumor location and histological type were prognostic factors, while surgery type was not a prognostic factor. Further stratified analyses according to tumor location revealed that OS was not significantly different between the two groups among patients with tumors located at the anastomotic site, while OS in the TG group was significantly better than that in the SG group among patients with tumors located in the gastric body (p = 0.046).
CONCLUSIONS
CONCLUSIONS
The results of the current study indicate that SG is a suitable alternative surgical procedure for GSC located at the anastomotic site after distal gastrectomy for benign lesions. The short-term outcomes and long-term prognoses of SG are comparable with those of TG.
Identifiants
pubmed: 32106866
doi: 10.1186/s12957-020-01821-y
pii: 10.1186/s12957-020-01821-y
pmc: PMC7047362
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
43Subventions
Organisme : National Natural Science Foundation of China
ID : 81772642
Références
Ann Surg Oncol. 2008 Jun;15(6):1632-9
pubmed: 18379851
Int J Surg. 2018 May;53:163-170
pubmed: 29602012
J Med Life. 2016 Apr-Jun;9(2):130-6
pubmed: 27453741
Eur J Surg Oncol. 2007 Mar;33(2):133-9
pubmed: 17071041
Int J Cancer. 2019 Apr 15;144(8):1941-1953
pubmed: 30350310
Ann Surg Oncol. 2011 Mar;18(3):670-6
pubmed: 21063791
World J Surg. 1998 Mar;22(3):254-60; discussion 260-1
pubmed: 9494417
Gastric Cancer. 2015 Apr;18(2):390-6
pubmed: 24705942
Ann Surg. 1922 Sep;76(3):405-8
pubmed: 17864703
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
Ann Surg. 2016 Apr;263(4):738-44
pubmed: 26501699
World J Surg Oncol. 2014 Jan 27;12:21
pubmed: 24468299
Isr Med Assoc J. 2011 Sep;13(9):534-6
pubmed: 21991712
World J Surg. 2010 Jul;34(7):1540-7
pubmed: 20182716
Ann Surg. 2012 Mar;255(3):478-85
pubmed: 22330040
J Surg Oncol. 2010 May 1;101(6):451-6
pubmed: 19924722
J Gastrointest Surg. 2016 Sep;20(9):1554-64
pubmed: 27364726
J Surg Oncol. 2015 Dec;112(8):877-82
pubmed: 26511335
Int J Surg. 2017 Nov;47:18-24
pubmed: 28935529
Ann Surg Oncol. 2014 Aug;21(8):2594-600
pubmed: 24639193
Ann Surg Oncol. 2016 Feb;23(2):511-21
pubmed: 26104543
BMC Cancer. 2017 May 19;17(1):345
pubmed: 28526077
Gastric Cancer. 2017 May;20(3):457-464
pubmed: 27638289
Ann Surg. 2013 Dec;258(6):970-5
pubmed: 24096753
Gastric Cancer. 2016 Apr;19(2):339-349
pubmed: 26667370
Surg Endosc. 2015 Nov;29(11):3196-204
pubmed: 25582964
Gastric Cancer. 2014 Apr;17(2):332-6
pubmed: 23832238
J Gastrointest Surg. 2014 Aug;18(8):1429-33
pubmed: 24944156
Langenbecks Arch Surg. 2019 Sep;404(6):753-760
pubmed: 31485734
J Am Coll Surg. 2015 Aug;221(2):291-9
pubmed: 26206635