الملخص
ABSTRACT Background: remnant gastric cancer (RGC) develops five years or later after previous resection for benign or malignant lesion. The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with higher rates of morbidity and mortality. Objective: to evaluate surgical results and survival after CTG in patients with RGC. Methods: 54 patients who underwent CTG between 2009 and 2019 were included in the study. As a comparison group 215 patients with primary gastric cancer (PGC) who underwent total gastrectomy (TG) in the same period were selected. Results: among the initial characteristics, age (68.0 vs. 60.5; p<0.001), hemoglobin values (10.9 vs. 12.3; p<0.001) and body mass index (22.5 vs. 24.6; p=0.005) were different between the RGC and PGC groups, respectively. The most frequent postoperative complications were related to pulmonary complications, infection and fistula in both groups. There was a higher incidence of esophagojejunal fistula in the CTG group (14.8% vs 6.5%, p=0.055). Perioperative mortality was higher in RGC patients (9.3% vs. 5.1%), but without significance (p=0.329). Hospital length of stay, postoperative complications graded by the Clavien-Dindo classification, mortality at 30 and 90 days were not different between groups. There was no significant difference in disease-free and overall survival between RGC and PGC groups. Conclusion: despite previous reports, surgical results and survival were similar between groups. Higher risk of esophagojejunal fistula must be considered.
RESUMO Antecedentes: o câncer do coto ou remanescente gástrico (CRG) se desenvolve cinco anos ou mais após a ressecção gástrica por lesão benigna ou maligna. O tratamento é realizado através da gastrectomia total complementar (GTC) com linfadenectomia. Alguns relatos consideram que esse procedimento pode estar associado a maiores taxas de morbimortalidade. Objetivo: avaliar os resultados cirúrgicos e a sobrevida após GTC em pacientes com CRG. Métodos: 54 pacientes submetidos a GTC entre 2009 e 2019 foram incluídos no estudo. Como grupo de comparação, foram selecionados 215 pacientes com câncer gástrico primário (CGP) submetidos à gastrectomia total (GT) no mesmo período. Resultados: dentre as características iniciais, a idade média (68,0 vs. 60,5; p <0,001), os valores de hemoglobina (10,9 vs. 12,3; p <0,001) e o índice de massa corporal (22,5 vs. 24,6; p = 0,005) diferiram entre os grupos CRG e CGP, respectivamente. As complicações pós-operatórias mais frequentes foram pulmonares, infecciosas e fístulas nos dois grupos. Houve maior incidência de fístula esofagojejunal no grupo GTC (14,8% vs 6,5%, p = 0,055). A mortalidade perioperatória foi maior nos pacientes com CRG (9,3% vs. 5,1%), mas sem significância (p = 0,329). O tempo de internação hospitalar, complicações pós-operatórias (Clavien-Dindo), mortalidade aos 30 e 90 dias não foram diferentes entre os grupos. Não houve diferença significativa na sobrevida livre de doença e global entre os grupos CRG e CGP. Conclusão: apesar dos relatos anteriores, os resultados cirúrgicos e a sobrevida foram semelhantes entre os grupos. Maior risco de fístula esofagojejunal dever ser considerado.
الموضوعات
Humans , Stomach Neoplasms/surgery , Gastric Stump/surgery , Gastrectomy , Lymph Node Excision , Postoperative Complications/epidemiology , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Brazil/epidemiology , Survival Analysis , Incidence , Survival Rate , Retrospective Studies , Gastric Stump/pathologyالملخص
We herein describe a case of cystic lymphangioma in the greater omentum of the remnant stomach, which is thought it to be related with subtotal gastrectomy 10 yr ago for early gastric cancer. A 76-yr-old man was admitted to our department with postprandial abdominal discomfort and bowel habit change. Intraabdominal multilocular cystic mass was detected by ultrasonography and computed tomography. We performed a complete En-bloc tumor resection including spleen and distal pancreas, and histological examination confirmed cystic lymphangioma originated from the greater omentum of the remnant stomach. Although the etiology of omental lymphangioma remains largely unclear, these findings suggested strongly that obstruction of the lymphatic vessels after gastric resection for gastric carcinoma might be the most plausible cause. The surgical extirpation with resection of organs involved appears to be a treatment of choice for such unusual case.
الموضوعات
Aged , Humans , Male , Gastrectomy , Gastric Stump/pathology , Lymphangioma, Cystic/pathology , Omentum/pathology , Stomach Neoplasms/surgeryالملخص
Gastritis cystica polyposa [GCP] is a rare inflammatory disease of the gastric remnant that usually develops after partial gastrectomy. It is defined by the presence of polyps on anastomotic gastric mucosa and at histopathobogicat examination, by the presence of mucosal and submucosal cysts with foveolar hyperplasia. The disease is characterized by the frequency of gastro-intestinal bleeding and possibility of carcinomatous association. We report seven cases of GCP collected over 5 years [1994-1999]. Diagnosis was made 9 to 45 years after partial gastrectomy and Finsterer. The patients were 52 to 72 years old. Revealing symptoms were cardiac failure, cardiac ischemia, melena, severe anemia and epigastric pain. For one patient, GCP was discovered casually. Endoscopic examination showed in all patients the presence of several polyps sized between 3 to 15 mm on the perianastomotic gastric remnant. Histology examination of the polyps showed microscopic a features of GCP in all cases. in one patient, there was a mild it glandular atrophy with extensive intestinal metaplasia and mild dysplasia. Helicobacter pylori was present only in this case
الموضوعات
Humans , Male , Female , Gastric Stump/pathology , Gastrectomy , Polyps , Reviewالملخص
El carcinoma de tipo linfoepitelioma, indiferenciado con estroma linfoide o medular, constituye un 3,8% de los carcinomas gástricos. Microscópicamente es similar a linfoepiteliomas de otras localizaciones, tiene crecimiento expansivo y mejor pronóstico que otros tipos histológicos. Se postula probable relación con el virus de Epstein Barr. Una mujer de 56 años gastrectomizada por cáncer hacía 31 años (Billroth) mostró en la endoscopía lesión ulcerada próxima a neboca. Se biopsió con resultado positivo y se realizó gastrectomía. Se recibió pieza que incluía muñón gástrico, yeyuno anastomosis, epiplón y glanglios. Presentaba lesión sobreelevada, ulcerada, de 4,5 cm ubicada en cara anterior a 1,5 cm de neoboca. Se efectuó fijación en formol buffer, procesamiento según métodos habituales y coloración con Hematoxilina-Eosina. Se realizaron técnicas de Inmunohistoquímica para CKAE1-AE3, EMA, CEA, CD45, CD20, CD3 y CD45Ro, y de PCR para virus de Epstein Barr. Microscópicamente estaba constituida por una proliferación expansiva de células poligonades con citoplasma ligeiramente eosinófilo y núcleos vesiculares, dispuestas en pequeños nidos o asiladas, positivas para CKES1-AE3, EMA y CEA, con denso infiltrado linfoide maduro, de disposición folicular y difuso, positivo para CD45, CD45Ro, CD3 y CD20. La técnica de PCR fue positiva. Éste es el primer caso de este tipo registrado en nuestro servicio desde 1989. Además de las características peculiares de esta variedad, cuyo diagnóstico diferencial debe haceres con los linfomas. es relevante su origen en muñón gástrico, donde esta complicación aparece con cifras variables, estando el riesgo vinculado al tipo de cirgía y tiempo transcurrido.
الموضوعات
Humans , Female , Middle Aged , Carcinoma/pathology , Gastrectomy , Gastric Stump/pathology , Lymphoid Tissue/pathology , Stomach Neoplasms/pathology , Carcinoma/surgery , Carcinoma/virology , DNA, Viral , /genetics , Postoperative Period , Stomach Neoplasms/surgery , Stomach Neoplasms/virology , Time Factorsالملخص
Os autores relatam o caso de um paciente submetido a gastrectomia parcial por úlcera duodenal sangrante há 29 anos, que após 24 anos da intervençäo cirúrgica passou a apresentar sintomatologia dispéptica em decorrência de gastrite alcalina de refluxo, de leve intensidade. No início houve resposta ao tratamento clínico e posteriormente, com piora dos sintomas, foi submetido a exame endoscópico, no qual diagnosticou-se lesäo elevada. Realizada biópsia cujo resultado revelou adenocarcinoma gástrico e, após tratamento cirúrgico, o estudo anatomopatológico da peça evidenciou câncer gástrico precoce, fato raro em nosso meio.
الموضوعات
Humans , Male , Middle Aged , Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Gastric Stump/pathology , Stomach Neoplasms/surgery , Stomach Neoplasms/diagnosis , Gastrectomyالملخص
Se revisan diferentes aspectos del problema que incluye el riesgo estimado post-cirugía gástrica, la relación del cáncer primario de muñón gástrico (CPMG) con el tipo de cirugía gástrica, la localización más frecuente, los aspectos histopatológicos, la patogenia, sintomatología y diagnóstico y la racionalización del tratamiento quirúrgico. Se concluye de esta revisión que no se conoce la prevalencia real del CPMG y el hecho de que la gran mayoría de las veces se diagnostica cuando el tumor está en fase avanzada
الموضوعات
Humans , Gastric Stump/surgery , Gastric Stump/physiopathology , Gastric Stump/pathology , Stomach Neoplasms/epidemiology , Stomach Neoplasms/physiopathology , Stomach Neoplasms/therapyالملخص
Os autores apresentam sua experiência com recorrência de adenocarcinoma em coto gástrico, perfazendo um total de cinco casos no período de 1981 a 1989, dos quais somente um caso foi passível de cirurgia com ressecçäo de intençäo curativa, com sobrevida de quatro meses. Fica-nos a impressäo de que o screening pós-operatório pode levar a aumento de taxas de re-ressecabilidade e sobrevida em casos precoces
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Adenocarcinoma/surgery , Gastric Stump/pathology , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/surgeryالملخص
O paciente gastrectomizado por doença benigna tem risco elevado de malignizaçäo da mucosa do coto gástrico e este trabalho tem como objetivo demonstrar as lesöes da mucosa do coto gástrico. Foram estudados 158 pacientes submetidos a gastrectomia preguessa e acompanhados com biópsias, de 1985 a 1993, ou provenientes de peças cirúrgicas de pacientes submetidos a degastrectomia. As alteraçöes histológicas mais frequêntes foram: gastrite crônica (78 por cento), hiperplasias foveolar (21 por cento), metaplasia intestinal (18 por cento), gástrite atrófica (15 por cento) e cistificaçäo glandular (17 por cento). Foram diagnosticadas 18 (11,4 por cento) neoplasias do coto gástrico, assim caracterizadas: adenocarcinoma tubular 13, adenocarcinoma em anel de sinete, 3; e adenocarcinoma indiferenciado, 2. A maior incidência de câncer do coto gástrico ocorreu 31 anos de pós-operatório (55 por cento). Todos os pacientes anteriores eram do sexo masculino, sendo 15 com reconstruçäo à BII e o restante à BI. Estes achados demonstram a importância do seguimento endoscópico no pós-operatório destes pacientes
الموضوعات
Humans , Male , Gastric Stump/pathology , Gastrectomy/adverse effects , Gastric Mucosa/pathology , Stomach Neoplasms/etiology , Postoperative Complications , Peptic Ulcer/surgery , Chi-Square Distributionالملخص
Gastric stump is a centre of miscellaneus pathologies. - We report 8 cases of cystic gastritis that were observed at patients aged. from 31 to 61 years with a 49 mean age with a male predominance [87,5%] which is in reality that of the operated duodenal ulcer. The mean supervening delay of this lesion was 13,8 years. Dysplasia was observed in 12,5% of cases. -Gastric Stump constitutes a precancerous condition. Dysplasia observed in cystic gastritis constitutes a precancerous lesion. It detecting must begin on and after 5 years after gastrectomy
الموضوعات
Humans , Gastric Stump/pathology , Precancerous Conditionsالملخص
Gastric stump is centre of miscellaneus pathologies. We report 8 carcinomas. Stump cancer happens 21.7 years et mean after gastrectomy in our patients. The mean age in our patients is 57 years with male predominance, in agreement with litterature data. Endoscopy have established the existence of minimal lesions in all cases. Biopsies were positive in 100% of cases with 5.4 Specimen mean number. These biopsies must be directed to proximity of anastomosis on its posterior wall against afferent ausa. 100% of our cases are carcinomas. Detecting must be annual and must begin 10 years after Surgery