Ikeguchi M, Oka S, Gomyo Y, Tsujitani S, Maeta M, Kaibara N
First Department of Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan.
Hepatogastroenterology. 2001 Sep-Oct;48(41):1517-20.
BACKGROUND/AIMS: Surgical technique and postoperative care for gastric cancer have significantly improved in recent years. However, whether postoperative morbidity or mortality rates after gastrectomy for gastric cancer were reduced or not in recent years was unclear. In this study, we analyzed the chronological changes of postoperative morbidity and mortality rates, and we analyzed risk factors for postoperative morbidity and mortality in patients undergoing gastrectomy for carcinomas of the stomach.
A total of 887 patients with gastric cancer were gastrectomized in our hospital between January 1985 and December 1996. The patients were divided into three groups on the basis of chronology. The first group included patients treated over the period 1985 to 1988 (n = 324); the second group, 1989 to 1992 (n = 300); and the third group, 1993 to 1996 (n = 263). Postoperative morbidity rates and mortality rates were compared among the three groups. Also, significant risk factors affecting postoperative morbidity and in-hospital mortality were analyzed by the multiple logistic regression analysis.
Postoperative complications were detected in 95 patients (10.7%) and in-hospital mortality rate was 2.4% (21/887). Postoperative morbidity rates were 10.5%, 11%, and 10.6% in the first, second, and third groups, respectively and postoperative mortality rates were 2.5%, 2%, and 2.7%, respectively. These postoperative morbidity and mortality rates were not different between the groups (P = 0.979 and P = 0.866). The most common postoperative complication was anastomotic leakage (56/95, 58.9%). Significant risk factors affecting in-hospital mortality were Stage IV (P = 0.006) and noncurative gastric resection (P = 0.004). However, the extent of lymph node dissection, combined resection, or the existence of preoperative complications were not significant risk factors of in-hospital mortality by multiple logistic regression analysis.
These results indicate that patients with far-advanced gastric cancer might have a high risk of postoperative mortality. In noncurative operations for patients with advanced gastric cancer, unnecessary lymph node dissection or combined resection should be avoided.
背景/目的：近年来，胃癌的手术技术和术后护理有了显著改善。然而，近年来胃癌胃切除术后的发病率和死亡率是否有所降低尚不清楚。在本研究中，我们分析了术后发病率和死亡率的时间变化，并分析了胃癌胃切除患者术后发病和死亡的危险因素。
1985年1月至1996年12月期间，我院共对887例胃癌患者实施了胃切除术。根据时间顺序将患者分为三组。第一组包括1985年至1988年期间接受治疗的患者（n = 324）；第二组为1989年至1992年（n = 300）；第三组为1993年至1996年（n = 263）。比较三组患者的术后发病率和死亡率。此外，通过多元逻辑回归分析，分析影响术后发病和院内死亡的显著危险因素。
95例患者（10.7%）出现术后并发症，院内死亡率为2.4%（21/887）。第一、二、三组的术后发病率分别为10.5%、11%和10.6%，术后死亡率分别为2.5%、2%和2.7%。这些术后发病率和死亡率在各组之间无差异（P = 0.979和P = 0.866）。最常见的术后并发症是吻合口漏（56/95，58.9%）。影响院内死亡的显著危险因素为IV期（P = 0.006）和非根治性胃切除术（P = 0.004）。然而，通过多元逻辑回归分析，淋巴结清扫范围、联合切除术或术前并发症的存在并非院内死亡的显著危险因素。
这些结果表明，晚期胃癌患者术后死亡风险可能较高。对于晚期胃癌患者的非根治性手术，应避免不必要的淋巴结清扫或联合切除术。
