Jagoditsch M, Pertl A, Jatzko G R, Denk H, Stettner H M
Chirurgische Abteilung, Krankenhaus der Barmherzigen Brüder St. Veit/Glan, Lehrkrankenhaus der medizinischen Fakultät, Universität Wien, Osterreich.
Chirurg. 2001 Jul;72(7):822-31. doi: 10.1007/s001040170111.
Although two large prospective and randomized planned European studies failed to show any benefit of radical D2 lymphadenectomy for gastric cancer, the value of radical lymphadenectomy is still a matter of controversy.
A radical surgical approach principally using D2, D3 lymphadenectomy, as defined by the Japanese Research Society for Gastric Cancer, has been prospectively performed since January 1984. Out of 729 patients with gastric cancer, 521 were surgically treated for potential cure between 1984 and 31 December, 1998. Clinical, histopathological and surgical factors were evaluated for their influence on long-term survival by means of univariate and multivariate analysis.
Tumor-specific 5- and 10-year survival rates for all patients were 58.5% and 57.5% for patients who underwent tumor resection 59% and 58%. For operated patients upon with the aim of achieving cures, the tumor-specific 5- and 10-year survival rates were 63.3% and 62.2% and the median survival time was more than 144 months. Postoperative hospital mortality was 7.7%, 4.6% for R0 resected patients, 8.6% for R1,2 resected patients and 21.3% for those undergoing palliative procedures. Multivariate analysis using the Cox model identified an age older than 65, total gastrectomy as well as high pN- and pT category as detrimental factors with an independent influence on survival.
After updating the long-term results of gastric cancer, as already published earlier, it is impressively obvious that also in a European setting of gastric cancer patients, with a presupposed appropriate surgical technique and experience, very constant cure rates are achievable with comparatively low mortality and morbidity.
尽管两项大型前瞻性随机欧洲研究未能显示出根治性D2淋巴结清扫术对胃癌有任何益处，但根治性淋巴结清扫术的价值仍存在争议。
自1984年1月起前瞻性地采用了一种主要使用日本胃癌研究学会定义的D2、D3淋巴结清扫术的根治性手术方法。在729例胃癌患者中，1984年至1998年12月31日期间有521例接受了旨在根治的手术治疗。通过单因素和多因素分析评估临床、组织病理学和手术因素对长期生存的影响。
所有患者的肿瘤特异性5年和10年生存率分别为58.5%和57.5%，接受肿瘤切除术的患者为59%和58%。以治愈为目的接受手术的患者，肿瘤特异性5年和10年生存率分别为63.3%和62.2%，中位生存时间超过144个月。术后医院死亡率为7.7%，R0切除患者为4.6%，R1、2切除患者为8.6%，接受姑息手术的患者为21.3%。使用Cox模型进行的多因素分析确定年龄大于65岁、全胃切除术以及高pN和pT类别为对生存有独立影响的不利因素。
在更新了已发表的早期胃癌长期结果后，令人印象深刻的是，在欧洲胃癌患者的背景下，在假定有适当手术技术和经验的情况下，也可以实现相当稳定的治愈率，且死亡率和发病率相对较低。
