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Từ kết quả nghiên cứu 66 BN (51 BN điều trị tại Bệnh viện Quân y 103 và 15 BN điều trị tại Bệnh viện K-cơ sở Tân Triều), chúng tôi thấy có những đóng góp mới như sau: Giá trị chụp cắt lớp vi tính ổ bụng trong chẩn đoán ung thư 1/3 dưới dạ dày được điều trị phẫu thuật triệt căn Chụp cắt lớp vi tính là phương pháp tốt để chẩn đoán ung thư 1/3 dưới dạ dày, giúp đánh giá chính xác tình trạng xâm lấn u, mức độ di căn hạch, di căn xa và giai đoạn bệnh. Tỷ lệ chẩn đoán đúng mức độ xâm lấn của chụp cắt lớp vi tính là 75,76%. Độ nhạy, độ đặc hiệu, giá trị tiên đoán dương, giá trị tiên đoán âm và độ chính xác của mức độ xâm lấn T1 là 55,56%; 96,49%; 71,43%; 93,22%; 90,91%. T2: 92,31%; 90,57%; 70,59%; 97,96%; 90,91%. T3: 86,36%; 84,09%; 73,08%; 92,50%; 84,85%. T4: 63,64%; 95,45%; 87,50%; 84,00%; 84,85%. Độ nhạy trong phát hiện di căn tạng của phương pháp chụp cắt lớp vi tính ổ bụng: 100%; độ đặc hiệu: 100%; giá trị tiên đoán dương tính: 100%; giá trị tiên đoán âm tính: 100%. Tỷ lệ chẩn đoán chính xác của chụp cắt lớp vi tính ổ bụng trong chẩn đoán di căn hạch: 62,12%. Độ nhạy, độ đặc hiệu, giá trị tiên đoán dương, giá trị tiên đoán âm và độ chính xác trong chẩn đoán di căn hạch là 78,26%; 65,00%; 83,72%; 56,52%; 74,24%. N1: 75,00%; 87,04%; 56,25%; 94,00%; 84,85%. N2: 68,00%; 85,37%; 73,91%; 81,40%; 78,79%. N3: 22,22%; 96,49%; 50,00%; 88,71%; 86,36%. Kết quả phẫu thuật triệt căn điều trị ung thư 1/3 dưới dạ dày Kết quả phẫu thuật điều trị ung thư dạ dày trong nghiên cứu là khả quan với tỷ lệ biến chứng thấp và thời gian sống thêm đáng khích lệ. Biến chứng sớm sau phẫu thuật ung thư dạ dày 1/3 dưới, tắc ruột có tỷ lệ 1,5%. Thời gian sống thêm toàn bộ trung bình là 73,16 ± 6,35 tháng. Tỷ lệ sống thêm toàn bộ theo Kaplan-Meier sau 1 năm là 87,9%, 2 năm là 66,4%, 3 năm là 54,0%, 4 năm là 54,0%, 5 năm là 54,0%. Tỷ lệ sống thêm 5 năm ở các giai đoạn tương ứng như sau: Ia, Ib, IIa, IIb, IIIa, IIIb, IIIc lần lượt là 77,8%; 72,9%; 37,6%; 70,0%; 33,3%; 36,4%. Thời gian sống thêm chung theo giai đoạn Ib, IIa, IIb, IIIa, IIIb, IIIC, IV là 70,46 ± 6,55 tháng. Tỷ lệ sống thêm 5 năm theo chặng hạch di căn N0 (64,5%), N1 (55,6%), N2(47,4%), N3a (50,0%). Thời gian sống thêm chung theo chặng hạch di căn N0, N1, N2, N3a, N3b là 73,16 ± 6,35. Cán bộ hướng dẫn 1 PGS. TS. Nguyễn Văn Xuyên Cán bộ hướng dẫn 2 PGS. TS. Lê Thanh Sơn Nghiên cứu sinh Heng Lihong THE NEW MAIN SCIENTIFIC CONTRIBUTIONS OF THE THESIS Name of thesis: “Research on the value of computed tomography and results of surgical treament in 1/3 lower gastric cancer” Specialized in: Surgery Code: 9 72 01 04 Full name of researcher: HENG LIHONG Full name of scientific instructors: 1. Assoc. Prof., PhD. Nguyen Van Xuyen 2. Assoc. Prof., PhD. Le Thanh Son Educational foundation: Vietnam Military Medical University The new scientific contributions of the thesis: From the study results, 66 gastric cancer patients diagnosed as the lower third gastric cancer, preoperatively computed tomography, operated at Military Hospital 103 and K Hospital (Tan Trieu campus), we found new contributions as follows: Value of abdominal computed tomography in the diagnosis of the 1/3 lower gastric cancer treated with radical surgery Computed tomography is a good method to diagnose cancer of the 1/3 lower of the stomach, helping to accurately assess tumor invasion, degree of lymph node metastasis, distant metastasis and stage of disease. The rate of correct diagnosis of invasiveness by computed tomography is 75.76%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of T1 invasion were 55.56%; 96.49%; 71.43%; 93.22%; 90.91%. T2: 92.31%; 90.57%; 70.59%; 97.96%; 90.91%. T3: 86.36%; 84.09%; 73.08%; 92.50%; 84.85%. T4: 63.64%; 95.45%; 87.50%; 84.00%; 84.85%. Sensitivity in detecting visceral metastasis of abdominal CT: 100%; specificity: 100%; positive predictive value: 100%; negative predictive value: 100%. Accurate diagnosis rate of abdominal computed tomography in the diagnosis of lymph node metastasis: 62.12%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy in the diagnosis of lymph node metastasis are 78.26%; 65.00%; 83.72%; 56.52%; 74.24%. N1: 75.00%; 87.04%; 56.25%; 94.00%; 84.85%. N2: 68.00%; 85.37%; 73.91%; 81.40%; 78.79%. N3: 22.22%; 96.49%; 50.00%; 88.71%; 86.36%. Results of radical surgery in the treatment of the 1/3 lower gastric cancer The outcome of gastric cancer surgery in the study was positive with low complication rate and encouraging survival time. Early complications after surgery for stomach cancer in the lower third, intestinal obstruction has a rate of 1.5%. The mean overall survival time was 73.16 ± 6.35 months. Overall survival rate according to Kaplan-Meier after 1 year was 87.9%, 2 years was 66.4%, 3 years was 54.0%, 4 years was 54.0%, 5 years was 54.0% . The 5-year survival rate at the respective stages is as follows: Ia, Ib, IIa, IIb, IIIa, IIIb, IIIc respectively 77.8%; 72.9%; 37.6%; 70.0%; 33.3%; 36.4%. The overall survival time according to stages Ib, IIa, IIb, IIIa, IIIb, IIIC, IV was 70.46 ± 6.55 months. The 5-year survival rate according to lymph node metastasis stage N0 (64.5%), N1 (55.6%), N2 (47.4%), N3a (50.0%). Overall survival time according to lymph node metastasis N0, N1, N2, N3a, N3b was 73.16 ± 6.35. The first supervisor
1 INTRODUCTION Necessary Gastric cancer (GC) is the most common malignancy in gastrointestinal cancers According to the announcement of the International Organization for Research on Cancer, in 2018, the world had 1,033,701 new cases and 782,685 deaths from gastric cancer, accounting for 5.7% of all cancers and 8.2% of the total mortality, ranking 5th in the world among common cancers and 2nd in mortality after lung cancer Vietnam belongs to an area of medium-high risk of gastric cancer, with a new incidence of 21.8 for men and 10.0 for women per 100,000 population Computed tomography (CT), a non-invasive method of diagnosing gastric cancer, allows to perform thin sections, reconstruct images in the vertical and horizontal directions Based on that, CT scan not only identifies the tumor, tumor location but also assesses the extent of invasion, invasive lymph nodes, metastasis of the tumor to intra-abdominal viscera, or distant metastasis to the lungs, bones, and other distant organs, play an important role in the diagnosis of TNM stages and help in better treatment options Currently, the CT scanning system is quite popular in many hospitals The application of preoperative CT scanning technique for gastric cancer patients is relatively convenient There are not many studies on CT in diagnosis and follow-up of gastric cancer, so we carried out a study on the topic: " Research on the value of computed tomography and results of surgical treament in 1/3 lower gastric cancer” Objectives - Imaging characteristics and value of computed tomography in patients with the lower third of the gastric cancer treated with radical surgery - Evaluation of the results of radical surgery in the treatment of the lower third gastric cancer Valudation of the project The results obtained through the research contribute to the specialty on the characteristics of computed tomography, histopathology in the diagnosis of the lower third of the gastric cancer and the results after radical surgery to treat the lower third the gatric cancer The topic has scientific significance, practical value, contributing to improving the quality of diagnosis and treatment, saving patients' lives, improving survival time in patients with the lower third of the gatric cancer Structure of the project The thesis has 118 pages, including the following parts: Introduction (2 pages), Chapter (Review of literature 35 pages), Chapter (Subjects and methods) 23 pages; Chapter (Results) 28 pages; Chapter (Discussion) 27 pages; Conclusion pages; Recommendation page The thesis has 49 tables, charts, 27 figures and 109 references (20 Vietnamese documents, 89 English documents) CHAPTER REVIEW OF LITERATURE 1.1 Epidemiological features of gastric cancer 1.2 Pathology and classification of gastric cancer 1.2.1 Pathological features of gastric cancer 1.2.2.1 Tumor location characteristics: Gastric cancer can be found in any location, but it is most common in the antrum-pyloric region with a rate of 70-80%; next, the lesser curvature region with the rate of 10-15%; in the cardiac, bulge region is about 3-5%; Greater curvature is rare 1.2.2.2 Macroscopic characteristics: Bormann classification includes nodules, ulcers, invasive ulcer, and infiltrate 1.2.2.3 Microscopic characteristics: classified according to World Health Organization and JGCR 3rd 1.2.2 Hình thức xâm lấn, di ung thư dày: Invasive and metastatic form of gastric cancer: local invasion, lymphatic metastasis, peritoneal cavity metastasis, hematogenous metastasis 1.2.3 Gastric cancer classification: gastric cancer classification according to the Japanese Gastric Cancer Association (2011) 1.3 Clinical and sublinical features of lower third gastric cancer Gastric cancer often has no obvious clinical symptoms, nonspecific symptoms can be epigastric pain, flatulence, dyspepsia, fatigue, anorexia, weight loss Anemia is also a symptom commonly found in UTIs The typical X-ray images of gastric cancer: lacunae, amputation usually corresponds to nodule, lenticular shapes correspond to ulcers, small rigid tubular stomach, loss of peristalsis corresponds to infiltrates Endoscopy is the earliest and most accurate diagnostic method available today The more biopsies, the greater the accuracy Endoscopy is a method of early diagnosis of gastric cancer, especially when combined with Indigocalmin staining to indicate the biopsy area 1.4 Computed tomography to diagnose gastric cancer 1.4.1 A brief history of the study of computed tomography in the diagnosis of gastric cancer 1.4.2 Anantomy of gastric computed tomography 1.4.3 Valuation and limitations of computed tomography in the diagnosis of gastric cancer 1.4.3.1 Image of gastric cancer on computed tomography: Focal thickening of the gastric wall with mucosal abnormalities, may form a protrusion into the lumen of the stomach, with a multilobar margin, jagged, may have or no ulcers; may or may not be symmetrical, after injection of strongly enhanced or non-enhanced contrast agent Normal gastric wall thickness is less than 5mm, gastric wall in cancerous lesions is defined as ≥1cm thickness Wall thickening with loss of normal mucosal folds Changes in gastric wall thickness accompanied by strong contrast enhancement are more pronounced than in the rest 1.4.3.2 Detecting tumor: 1.4.3.3 Tumor location: The most common gastric cancer is in the antrum and pyloric areas In recent years, cardiac gastric cancer tends to increase 1.4.3.4 Macroscopic assessment of gastric cancer: early gastric cancer, nodular, non-invasive ulcerative, invasive ulcerative, infiltrative and unclassified 1.4.3.5 Assessment of tumor invasion: T1, T2, T3, T4 invasion 1.4.3.6 Evaluation of lymph node metastasis: Evaluation of lymph node metastasis on CT remains a big challenge even with the generation of multi-detector arrays The lymph node is considered pathological when the short axial diameter of the lymph node is more than mm for perigastric lymph nodes and more than mm for other sites N1, N2, N3 lymph node metastasis 1.4.3.7 Evaluation of distant metastases: Gastric cancer often metastasizes to the liver, lymph nodes, peritoneum, ovaries, etc Distant metastasis is a poor prognostic factor 1.5 Stomach cancer surgical treatment 1.5.1 Radical treatment Surgery is the mainstay of treatment for GC In the early stage, the cancer is still localized, surgery is the method of choice for radical treatment At a later stage, surgery is considered a basic method combined with adjuvant methods such as postoperative chemotherapy, pre- and postoperative radiation therapy, and biological treatment 1.5.2 Temporary treatment of the lower third gastric cancer 1.6 Results of treatment for gastric cancer 1.6.1 Early results of surgery The early surgical outcomes include intraoperative accidentes and deaths, complications, and postoperative mortality Postoperative mortality was defined as patients who were critically ill, dying, or died within the first 30 days after surgery Postoperative complications may be encountered such as: peritonitis, oesophageal fistula, duodenal apex fistula, postoperative bleeding, oropharyngeal bleeding… 1.6.2 Late results after surgery: Cancer in general and gastric cancer in particular often recur in the first years after treatment, especially in the first years Surgery for radical treatment of gastric cancer with the expectation of cure of gastric cancer In the US and Western countries, the 5-year survival rate in patients undergoing radical surgery is about 25-30%, the 5-year overall survival rate is about 4-10% In Japan, the 5-year overall survival rate is about 57%, the 5-year survival rate after gastrectomy is about 61%, and the surgical mortality rate is only about 1% CHAPTER SUBJECTS AND METHODS 2.1 Subjects Including 66 gastric cancer patients diagnosed as the lower third gastric cancer, preoperatively computed tomography, operated at Military Hospital 103 and K Hospital (Tan Trieu campus) from 2009 to 2017 2.1.1 Criteria of selection Patients with histopathological diagnosis of adenocarcinoma of the lower third of the stomach (defined as carcinoma according to WHO regulations and the tumor location in the lower third according to JGCA 3rd) - Get a computerized tomography (CT) film of the abdomen with contrast injection - Have not had any other type of cancer - The patient was treated with radical surgery to treat gastric cancer The radical treatment of the lower third gastric cancer is performed according to the following principles: + Gastric bypass: in the lower part of the duodenum, - cm from the pylorus At the top, cut at least 6cm from the lesion + Remove all the great omentum, the small omentum together with the superior area of the transverse mesentery + Remove the metastatic lymph node system: remove gastric lymph nodes to level D2 + Radical resection of invasive or metastatic organs: Invaded organs such as colon, tail of pancreas, liver or metastases, such as ovaries, need to be removed along with the tumor 2.1.2 Exclusion criteria - The patient did not receive surgical treatment - Patients with incorrect technique of CT scan - Patient has cancer in other organs - The medical record is not full of research information 2.2 Methods - Retrospective, prospective, descriptive cross-sectional study, longitudinal follow-up to evaluate postoperative outcomes 2.2.1 Research indexes 2.2.1.1 Research criteria and general characteristics of patients - Age (year), gender (male/female) - Time of illness - Functional symptoms, physical symptoms 2.2.1.2 Research indicators on computed tomography with gastric cancer - Tumor diagnostic signs: - Tumor limit: - Tumor position: - Tumor size: - Tumor thickness: - Tumor shape: nodules, ulcerative, invasive and infiltrative - Density, tumor enhancement properties: - Invasive nature: T1, T2, T3, T4 level - Research criteria on lymph node metastasis: number of lymph nodes, lymph node location, degree of lymph node metastasis N1, N2, N3 - Research criteria on distant metastasis on CT: M0, M1 - Research indicators on diagnosis of disease stage on CT: Based on CT results of T, N, and M, determine the stage of lower third gastric cancer on CT according to JGCA3rd 2.2.1.3 Research criteria for radical treatment of the lower third gastric cancer - Surgical methods; Method of closing the duodenal apex; Methods of re-establishing gastrointestinal circulation; Surgery time: - Early post-operative results: time after surgery, length of hospital stay, complications, postoperative complications, mortality rate due to surgery - Late results after surgery: postoperative complications, recurrence rate, postoperative metastasis, postoperative survival time 2.2.1.3 Research criteria on pathology 2.3 Statistically analysis The study was processed using SPSS 22.0 software 2.4 Research ethics - This study was conducted after the detailed outline was approved by the Department, permission and support from the Party Committee, the Board of Directors of the Military Medical Academy, the 103 Military Hospital and the K hospital Tan Trieu) and authorities - The data collected in this study is honest, the research process does not affect the medical examination and treatment activities at the relevant clinical departments - Patient information is kept confidential - Medical records during the research process are stored and preserved carefully, without causing loss 7 CHAPTER RESULTS There were a total of 66 patients (51 patients treated at Military Medical Hospital 103 and 15 patients treated at K Hospital - Tan Trieu facility) who met the selection criteria and were included in the study We get the following results: 3.1 Some characteristics of the lower third gastric cancer 3.1.1 Epidemiological features Table Age and sex characteristics Sex (n, %) Age group n Rate % Male Female ≤ 40 2(4.17) 4(22.22) 9.09 41 – 50 5(10.42) 4(22.22) 13.64 51 – 60 22(45.83) 4(22.22) 26 39.39 61 – 70 11(22.9) 4(22.2) 15 22.7 > 70 8(16.67) 2(11.11) 10 15.15 Total 48(72.73) 18(27.27) 66 100 Mean 59.04 ± 10.56 54.33 ± 14.21 57.76 ± 11.74 Min-Max (31 – 79) (36 – 81) (31 – 81) Comment: The average age of the study group was 57.76 ± 11.74 (years), in which the oldest person was 81, the youngest was 31 The rate of gastric cancer in men was 72.73% higher than female is 27.27% The age group 51-60 is the age group with the highest rate of gastric cancer with 39.39%, the rate of gastric cancer is low in the age group ≤ 40 (9.09%) 3.1.2 Clinical and paraclinical features Table Clinical features Symptoms Number (n) Rate (%) Anorexia-full stomach 28 42.42 Indigestion-nausea 28 42.42 Fatigue-loss weight 32 48.48 Epigastric pain 50 75.76 intermittently Constant abdominal 25 37.88 pain Black stools 10 15.15 Vomiting with blood 3.03 Vomiting without blood 18 27.27 pyloric stenosis 3.03 Comment: The symptoms encountered with the highest rate were: abdominal pain (75.76%), followed by fatigue, weight loss (48.48%), anorexia, bloating (42.42%), hematemesis symptoms (3.03%), pyloric stenosis are rare 3.2 Value of computed tomography image of the lower third gastric cancer 3.2.1 Tumor characteristics on computed tomography Table 3.3 Tumor location on CT Tumor location on CT Number (n) Rate (%) Bờ cong nhỏ 17 25.76 Lesser curvature Pyloric antrum 49 74.24 Total 66 100 Comments: In 66 patients with gastric tumor detected on CT film, tumors in the antrum and pyloric positions accounted for 74.24%; the remaining 25.76% are tumors in the position of lesser curvature Table 3.4 Invasion, metastasis of tumor on computed tomography Tumor Number (n=66) Rate (%) T1 10.61 T2 17 25.76 T3 26 39.39 T4a 16 24.24 Tổng 66 100 Lymph nodes N0 23 34.85 N1 16 24.24 N2 23 34.85 N3 6.06 Tổng 66 100 Metastasis M0 64 96.97 M1 3.03 Comments: On CT scan, tumors with T3 invasiveness are predominant, accounting for 39.39%; T4 invasion was 24.24%; T2 invasion was 25.76%; T1 invasion was 10.61% On CT scan, no metastatic lymph nodes were detected, accounting for 34.85% Metastasis in the group of lymph nodes N1, N2 and N3 was 24.24%, respectively; 34.85% and 6.06% There were two cases with diagnosis of distant metastasis on CT, liver metastasis Table 3.5 Stage of gastric cancer on computed tomography Stages Number (n) Rate (%) Ia 4.55 Ib 13.64 IIa 16 24.24 IIb 15 22.73 IIIa 10 15.15 IIIb 10.61 IIIc 6.06 IV 3.03 Total 66 100 Nhận xét: Comment: Stage IIa has the highest rate with 24.24%; stage IIb is 22.73%; stage Ia (4.55%); stage Ib (13.64%); stage IIIa (15.15%); stage IIIb (10.61%); stage IIIc (6.06%); stage IV (3.03%) There are cases in stage IV (3.03%), both are liver metastases 3.2.2 Value of computed tomography in the diagnosis of gastric cancer of the lower third Table 3.6 Comparison of invasiveness between computed tomography and pathology Pathology CT T1 T4 T2 T1 T2 T3 T1a T1b 1(50.00 ) 1(50.00 ) 4(57.14 ) 1(7.69) 0(0.00) 12(92.31 ) 1(4.55) 2(13.33) 0(0.00) 19(86.36 ) 2(13.33) 0(0.00) 2(28.57 ) Total T3 T4a 1(4.55) 0(0.00) T4b 0(0.00) 7(10.61) 1(14.29 ) 3(42.86 ) 17(25.76 ) 26(39.39 ) 10 T4a 0(0.00) Total 2(3.03) 1(14.29 ) 7(10.61 ) 0(0.00) 1(4.55) 13(19.70 ) 22(33.33 ) 11(73.33 ) 15(22.73 ) 3(42.86 ) 7(10.61 ) 16(24.24 ) 66(100) Comment: The rate of correct diagnosis of invasiveness of CT scan with pathology: (5+12+19+14)/66 = 75.76% Sensitivity corresponding to the degree of invasion, respectively: T1: 5/9 = 55.56%; T2: 12/13 = 92.31%; T3: 19/22 = 86.36%; T4: 14/22 = 63.64% The specificity corresponds to the levels of invasion, respectively: T1: 55/57 = 96.49%; T2: 48/53 = 90.57%; T3: 37/44 = 84.09%; T4: 42/44 = 95.45% The positive predictive value corresponds to the levels of invasion, respectively: T1: 5/7 = 71.43%; T2: 12/17 = 70.59%; T3: 19/26 = 73.08%; T4: 14/16 = 87.50% The negative predictive value corresponds to the levels of invasion, respectively: T1: 55/59 = 93.22%; T2: 48/49 = 97.96%; T3: 37/40 = 92.50%; T4: 42/50 = 84.00% The accuracy in diagnosis corresponds to the levels of invasion, respectively: T1: 60/66 = 90.91%; T2: 60/66 = 90.91%; T3: 56/66 = 84.85%; T4: 56/66 = 84.85% Table 3.7 Comparison of visceral metastases between computed tomography and pathology Pathology CT Total M0 % M1 % M0 64 100 0.00 64(96.97) M1 0.00 100 2(3.03) Total 64 96.97 3.03 66(100) Comment: There were patients with visceral metastases identified on preoperative abdominal CT Through the above table, we found that the sensitivity in detecting visceral metastases of the abdominal CT scan method: 2/2 = 100%; specificity: 64/64 = 100%; positive predictive value: 2/2 = 100%; negative predictive value: 64/64 = 100% Accuracy: (64 + 2)/66 = 100% Table 3.8 Comparison of lymph node metastasis between computed tomography and pathology Pathology CT N0 N0 N1 N2 13(65.00) 1(8.33) 6(26.09) N3 Total N3a N3b 3(37.50) 0(0.00) 23(34.85) 11 N1 4(20.00) 9(75.00) 1(4.00) 2(25.00) 0(0.00) 16(24.24) N2 2(10.00) 2(16.67) 17(68.00) 1(12.50) 1(100) 23(34.85) N3 1(5.00) 0(0.00) 1(4.00) 2(25.00) 0(0.00) 4(6.06) Total 20(30.30) 12(18.18) 25(37.88) 8(12.12) 1(1.52) 66(100) Comment: Accurate diagnosis rate of abdominal CT scan in diagnosing metastasis in gastric cancer lymph nodes: (13+9+17+2)/66 = 62.12% Sensitivity corresponding to the diagnosis of lymph node metastasis and the degree of lymph node metastasis, respectively: N: 36/46 = 78.26%; N1: 9/12 = 75.00%; N2: 17/25 = 68.00%; N3: 2/9 = 22.22% The specificity corresponding to the diagnosis of lymph node metastasis and the degree of lymph node metastasis, respectively: N: 13/20 = 65.00%; N1: 47/54 = 87.04%; N2: 35/41 = 85.37%; N3: 55/57 = 96.49% The positive predictive value corresponds to the diagnosis of lymph node metastasis and the degree of lymph node metastasis, respectively: N: 36/43 = 83.72%; N1: 9/16 = 56.25%; N2: 17/23 = 73.91%; N3: 2/2 = 50.00% The negative predictive value corresponds to the diagnosis of lymph node metastasis and the degree of lymph node metastasis, respectively: N: 13/23 = 56.52%; N1: 47/50 = 94.00%; N2: 35/43 = 81.40%; N3: 55/62 = 88.71% The accuracy corresponding to the diagnosis of lymph node metastasis and the degree of lymph node metastasis, respectively: N: 49/66 = 74.24%; N1: 56/66 = 84.85%; N2: 52/66 = 78.79%; N3: 57/66 = 86.36% Table 3.9 Comparison of disease stage between computed tomography and pathology Pathology Total CT Ia Ib IIa IIb IIIa IIIb IIIc Ia (100) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) Ib (11.11 ) (55.5 6) (11.11 ) (0.00) (0.0) (6.25) (11.11 ) (12.5 0) (0.00) IIa (11.11 ) (37.5 0) (25.0 0) (6.25) (12.5 0) IV (0.00 ) (0.00 ) (0.00 ) (4.55) (13.64 ) 16 (24.24 ) 12 Pathology Total CT Ia Ib IIa IIb IIb (0.00) (20.0 0) (6.67) IIIa (0.00) (0.00) (0.00) IIIb (0.00) (0.00) (0.00) IIIc (0.00) (0.00) (0.00) IV (0.00) (0.00) (0.00) (0.00) Tota l (6.06) (13.6 4) (12.1 2) 16 (24.2 4) 10 (66.6 7) (10.0 0) (14.2 9) (25.0 0) IIIa IIIb IIIc (0.00) (6.67) (0.00) (50.0 0) (14.2 9) (10.0 0) (14.2 9) (25.0 0) (30.0 0) (57.1 4) (50.0 0) (0.00) (0.00) (0.00) 10 (15.1 5) (9.09) 11 (16.6 7) (0.00) IV (0.00 ) (0.00 ) (0.00 ) (0.00 ) (100 ) (3.03 ) 15 (22.73 ) 10 (15.15 ) (10.61 ) (6.06) (3.03) 66 (100) Comment: Accurate diagnosis rate of abdominal CT scan in diagnosing gastric cancer stage: (3+5+6+10+5+1+2+2)/66 = 51.52% Sensitivity corresponding to disease stages, respectively: Ia: 3/4 = 75.00%; Ib: 5/9 = 55.56%; IIa: 6/8 = 75.00%; IIb: 10/16 = 62.50%; IIIa: 5/10 = 50.00%; IIIb: 1/6 = 16.67%; IIIc: 2/11 = 18.18%; IV: 2/2 = 100.00% Specificity corresponding to the disease stages respectively: Ia: 62/62 = 100.00%; Ib: 53/57 = 92.98%; IIa: 48/58 = 82.76%; IIb: 45/50 = 90.00%; IIIa: 51/56 = 91.07%; IIIb: 54/60 = 90.00%; IIIc: 53/55 = 96.36%; IV: 64/64 = 100.00% Positive predictive value corresponding to the disease stages respectively: Ia: 3/3 = 100.00%; Ib: 5/9 = 55.56%; IIa: 6/16 = 37.50%; IIb: 10/15 = 66.67%; IIIa: 5/10 = 50.00%; IIIb: 1/7 = 14.29%; IIIc: 2/4 = 50.00%; IV: 2/2 = 100.00% Negative predictive value corresponding to the disease stages respectively: Ia: 62/63 = 98.41%; Ib: 53/57 = 92.98%; IIa: 48/50 = 96.00%; IIb: 45/50 = 88.24%; IIIa: 51/56 = 91.07%; IIIb: 54/59 = 91.53%; IIIc: 53/62 = 85.48%; IV: 64/64 = 100.00% The accuracy corresponding to the disease stages in turn: Ia: 65/66 = 98.48%; Ib: 58/66 = 87.88%; IIa: 54/66 = 81.82%; IIb: 55/66 = 83.33%; IIIa: 56/66 = 84.85%; IIIb: 55/66 = 83.33%; IIIc: 55/66 = 83.33%; IV: 66/66 = 100.00% 13 3.3 Results of surgery for the lower third gastric cancer 3.3.1 Surgical method Table 3.10 Relationship between surgical way and surgery time The way of surgery Numbe r (n) Rate (%) Surgery time (minutes) p Laparotomy 39 59.09 153.85 ± 34.31 surgery 0.05 3.3.2 Results after surgery * Early results after surgery Results after surgery, the patient recovered after 2.2 ± 0.23 days, and fart after 50.2 ± 6.8 hours The patients in our study were removed drain after 3.8 ± 0.5 days The mean hospital stay was 7.4 ± 1.2 days Table 3.12 Complications after surgery Complications after surgery Number (n) Rate (%) No 65 98.48 Bowel obstruction 1.52 Total 66 100 Comment: There was case with complications of intestinal obstruction after surgery * Late results after surgery Table 13 Follow-up results after years Follow-up results after years n Rate (%) Alive 37 56.06 Deaths 29 43.94 Total 66 100 Comments: Of the 66 research subjects, 37 were alive (accounting for 56.06%), 29 were dead (43.94%) The surviving diseases were reexamined, no local recurrence and distant metastasis were detected The patients who died, we asked, learned information related to the cause of death, the patients died mainly due to old age, weakness, high dose chemotherapy, patients with reduced ability to eating and drinking leads to weariness and exhaustion No patient died from recurrence or distant metastasis Table 14 Total survival time according to Kaplan-Meier Survival time ≥1 ≥2 ≥3 ≥4 ≥5 The survival ability year year year year year s s s s s Cumulative number of dead 22 29 29 29 patients Cumulative survival rate (%) 87.9 66.4 54.0 54.0 54.0 15 TB ± SE (months) 73.16 ± 6.35 95% CI 60.71 – 85.61 Comment: The mean overall survival time was 73.16 ± 6.35 months There were 29 patients died during the follow-up period, the overall mortality rate after years was 29/66 (43.94%) Overall survival according to KaplanMeier at year was 87.9% Overall survival according to Kaplan-Meier after years was 66.4% Overall survival according to Kaplan-Meier after 3, and years were 54.0% Figure 3.1 Total survival time Table 15 Overall survival time by disease stage 5-year Stages N survival rate TB ± SE 95% CI (%) Ia 100 Ib 77.8 98.67 ± 12.69 73.80 – 123.53 IIa 72.9 68.96 ± 9.15 51.03 – 86.89 IIb 16 37.6 53.53 ± 10.60 32.75 – 74.31 IIIa 10 70.0 57.50 ± 7.99 41.85 – 73.15 IIIb 33.3 32.83 ± 6.17 20.75 – 44.92 IIIc 11 36.4 26.18 ± 6.88 12.69 – 39.67 IV 0.0 11.50 ± 1.50 8.56 – 14.44 Total 66 70.46 ± 6.55 57.62 – 83.31 Comment: There are patients in stage Ia who are 100% alive The 5-year survival rate at the respective stages is as follows: Ia, Ib, IIa, IIb, IIIa, IIIb, IIIc respectively 77.8%; 72.9%; 37.6%; 70.0%; 33.3%; 36.4% There are cases of stage IV survival 11.50 ± 1.50 months case lived for 10 months, case lived for 13 months The overall survival time according to stages Ib, IIa, IIb, IIIa, IIIb, IIIC, IV is 70.46 ± p Test Log Rank χ2 = 21.822 df = p= 0.001 16 6.55 months, statistically significant difference with p