Samson Prudencio S, Escovidal Laurence Anthony P, Yrastorza Samuel G, Veneracion Ronaldo G, Nerves Mary Yvonnette C
Department of Surgery, East Avenue Medical Center, East Avenue, Diliman 1100, Quezon City, Philippines.
World J Surg. 2002 Apr;26(4):428-33. doi: 10.1007/s00268-001-0243-9. Epub 2002 Feb 4.
Cancer of the stomach (CaS) is a dreaded disease. Fortunately, there is a decreasing incidence, except in the East. The authors did a re-study of CaS, a widely investigated but unresolved gastrointestinal malignancy. The clinicopathologic features were evaluated to identify and measure the prognostic factors that would help the surgeon decide optimal therapy. Among 383 admitted for CaS at the East Avenue Medical Center, Quezon City, Philippines between January 1987 and December 1996, 149 underwent radical resection with curative intent. (As historical control, the experience in 136 cases was reviewed during the immediately preceding 5-year period [1982-1986] when extended lymphadenectomy was not the standard policy.) For staging, the TNM system (tumor-node-metastasis) was used; to describe anatomy and surgery of stomach lymphatics, the "Japanese Rules," as modified, were adapted. Curative radical gastrectomy would include removal of the diseased stomach and regional lymphatics as defined by frozen section, including subtotal (or total) gastrectomy and "extended" D2 (with no. 12) node dissection. The clinicopathologic factors were statistically analyzed, using the accepted methods: Kaplan-Meier for survival, univariate analysis, and multivariate analysis for independent predictors. Of the 12 risk factors assessed by univariate analysis, the following were identified by multivariate analysis as independent prognosticators of survival: (1) wall penetration; (2) node invasion; (3) TNM stage; (4) resection margin; and (5) tumor size. After curative resection, the operative mortality was 5.3% and the complications, 19.4%. The 5-year survival was 60.4%, and recurrence, 15.4%. The results have shown that the pathology-related factors, (1) wall penetration; (2) node invasion; and (3) resection margin, are independent prognosticators of survival, remarkably affecting outcome. In conclusion, the study supports radical gastrectomy with extended D2 lymphadenectomy for CaS as safe and effective. Survival and recurrence are a function of pathology and adequate resection; operative mortality is defined by the patient's condition.
胃癌是一种可怕的疾病。幸运的是，除了在东方地区，其发病率正在下降。作者对胃癌进行了重新研究，胃癌是一种广泛研究但尚未解决的胃肠道恶性肿瘤。对其临床病理特征进行评估，以识别和衡量有助于外科医生决定最佳治疗方案的预后因素。1987年1月至1996年12月期间，在菲律宾奎松市东大街医疗中心收治的383例胃癌患者中，149例接受了根治性切除手术，目的是治愈。（作为历史对照，回顾了在此之前5年期间（1982 - 1986年）136例患者的经验，当时扩大淋巴结清扫术并非标准治疗方案。）对于分期，采用TNM系统（肿瘤 - 淋巴结 - 转移）；为描述胃淋巴管的解剖结构和手术情况，采用了修改后的“日本规则”。根治性根治性胃切除术包括切除病变胃和根据冰冻切片确定的区域淋巴结，包括次全（或全）胃切除术和“扩大”的D2（包括第12组）淋巴结清扫术。使用公认的方法对临床病理因素进行统计学分析：使用Kaplan - Meier法计算生存率，进行单因素分析，并对独立预测因素进行多因素分析。在单因素分析评估的12个风险因素中，多因素分析确定以下因素为生存的独立预后因素：（1）胃壁穿透；（2）淋巴结侵犯；（3）TNM分期；（4）手术切缘；（5）肿瘤大小。根治性切除术后，手术死亡率为5.3%，并发症发生率为19.4%。5年生存率为60.4%，复发率为15.4%。结果表明，与病理相关的因素，（1）胃壁穿透；（2）淋巴结侵犯；（3）手术切缘，是生存的独立预后因素，对结果有显著影响。总之，该研究支持对胃癌进行扩大D2淋巴结清扫的根治性胃切除术，认为其安全有效。生存和复发是病理和充分切除的函数；手术死亡率取决于患者的病情。
