Yokota T, Kunii Y, Saito T, Teshima S, Yamada Y, Iwamoto K, Takahashi H, Takahashi M, Kikuchi S, Yamauchi H
Department of Surgery, Sendai National Hospital, Sendai 983-8520, Japan.
Eur J Surg Oncol. 2002 Apr;28(3):209-13. doi: 10.1053/ejso.2001.1178.
A recent trend in the surgical treatment of patients with early gastric cancer in Japan has been to limit surgery to an extent that ensures complete cure and improvement in the patient's quality of life. If a gastric cancer tumour can be completely eradicated by laparoscopic surgery, the patient can be cured of cancer without major operative stress. A small gastric cancer tumour of less than 2 cm in diameter is an indication for laparoscopic surgery, but little is known about what protocol of surgical treatment is appropriate for this type of tumour.
The clinicopathological features of 150 patients with gastric cancer tumour of less than 2 cm in diameter were reviewed retrospectively from hospital records between 1985 and 1995. The results of retrospective analysis of clinicopathological data of 24 patients with advanced cancer were compared with those of 126 patients with early cancer. Univariate and multivariate analyses of patients with small gastric cancer tumours were performed to evaluate the prognostic significance of clinicopathological features.
A significant difference was seen between the gross tumour appearances in the two groups; Borrmann type-4 tumours were more common in the advanced group. Lymph-node metastasis, lymphatic vessel invasion and vascular invasion were found more frequently in the advanced cancer group than in the early cancer group. Scirrhous type was more common in the advanced cancer group. In univariate analysis, unfavourable prognostic factors included deep cancer invasion, presence of lymph-node metastasis, lymphatic invasion and vascular invasion. Using Cox's proportional hazard regression model, only nodal involvement emerged as an independent statistically significant prognostic parameter associated with long-term survival.
Laparoscopic surgery should not be performed on tumours that are Borrmann type in macroscopic appearance and scirrhous-type histologically. Lymph-node metastasis is an independent prognostic factor. We recommend laparoscopic surgery involving local resection of the stomach without lymphadenectomy for small, early gastric cancer tumours that satisfy the criteria mentioned above. However, the validity of this recommendation should be tested by a prospective randomized control trial in the future.
在日本，早期胃癌患者外科治疗的一个最新趋势是将手术范围限制在确保完全治愈并改善患者生活质量的程度。如果胃癌肿瘤能够通过腹腔镜手术完全根除，患者就能在没有重大手术应激的情况下治愈癌症。直径小于2厘米的小胃癌肿瘤是腹腔镜手术的适应证，但对于这类肿瘤何种手术治疗方案合适却知之甚少。
回顾性分析了1985年至1995年间150例直径小于2厘米的胃癌肿瘤患者的临床病理特征。将24例进展期癌症患者的临床病理数据回顾性分析结果与126例早期癌症患者的结果进行了比较。对小胃癌肿瘤患者进行单因素和多因素分析，以评估临床病理特征的预后意义。
两组间肿瘤大体外观存在显著差异；进展期组中Borrmann 4型肿瘤更为常见。进展期癌症组中淋巴结转移、淋巴管侵犯和血管侵犯的发生率高于早期癌症组。硬癌型在进展期癌症组中更为常见。在单因素分析中，不良预后因素包括癌症侵犯深度、存在淋巴结转移、淋巴管侵犯和血管侵犯。使用Cox比例风险回归模型，只有淋巴结受累是与长期生存相关的独立统计学显著预后参数。
对于宏观外观为Borrmann型且组织学为硬癌型的肿瘤不应进行腹腔镜手术。淋巴结转移是一个独立的预后因素。对于符合上述标准的小的早期胃癌肿瘤，我们建议进行不包括淋巴结清扫的胃局部切除的腹腔镜手术。然而，这一建议的有效性未来应通过前瞻性随机对照试验进行验证。
