잔위암의 임상적 고찰
-대한위암학회 분류에 의거-
Clinical Analysis of the Gastric Stump Cancer
-Classification Proposed by the Korean Gastric Cancer Association-
Wook Kim, M.D., Joon Hyun Lee, M.D, Jin Jo Kim, M.D., Hyung Min Chin, M.D., Hae Myung Jeon, M.D., Cho Hyun Park, M.D., Seung Man Park, M.D., Woo Bae Park, M.D., Keun Woo Lim, M.D. and Seung Nam Kim, M.D.
Purpose: The aim of this study is to evaluate the clinico- pathological features and treatment results of 49 cases of gastric stump cancer based on the classification proposed by the Korean Gastric Cancer Association.
Methods: A total of 49 patients with gastric stump cancer, who underwent operation from 1991 to 2000, were divided into three group: primary cancer (group I, n=20), remnant cancer (group II, n=15) and recurrent cancer (group III, n=14). The clinicopathological features and patient survivors in each groups were analyzed and compared with the primary upper one third cancer patients.
Results: The incidence of operated stump cancer was 0.8%
(49/6,445 cases) during the ten years. The male to female ratio was 3.9 1 and mean age was 56.5 years (range 39 83 years). The resectability was 96% (47/49 cases) and curability was 73.4% (36/49 cases). There were 16 (80%), 1 (7%), 0 (0%) cases of benign primary disease and 4 (20%), 14 (93%), 14 (100%) cases of malignant primary disease in each group, respectively. The mean duration from primary disease to stump cancer was 21.7 years (10 40 years) in group I, 3.4 years (4 months 9 years 2 months) in group II and 3.4 years (1 year 7 years 5 months) in group III. The 5 year-survival rate was 45.1% in group I, 63.5% in group II and 0% in group III. But there was no
statistic differences in 5 year-survival rates between stump cancer (33.0%) and primary cancer of the upper one third (30.9%).
Conclusion: The condition of the primary disease, tumor location, duration of cancer development and tumor stage had statistical differences between the three groups. In the case of benign disease, the patients belonged in the high-risk group for the new development of gastric cancer following 20 years. Early detection of cancer in the remnant stomach by periodic follow up is important, especially in high-risk groups, and application of aggressive surgical treatment will improve patient survival. (J Korean Surg Soc 2004;66:177-182)
Key Words: Gastric stump cancer, Classification, Survivals
: , ,
Department of Surgery, College of Medicine, The Catholic
University of Korea, Seoul, Korea
0
P=0.058 1.0
60
Survival rate
Months
0 40
Remnant cancer (n=15)
Primary cancer (n=20) Recurrent cancer (n=14)
20 .8
.6 .4 .2
0 1.0
60
Survival rate
Months
Carcinoma of upper 1/3 of stomach (n=93) Carcinoma of gastric stump (n=49)
0 20 40
.8 .6 .4 .2
P=0.574
