Sigon Roberto, Canzonieri Vincenzo, Rossi Carlo
Surgical Oncology Department, Centro di Riferimento Oncologico (CRO), Istituto Nazionale Tumori, Via Pedemontana Occidentale 12, 33081 Aviano PN, Italy.
Suppl Tumori. 2003 Sep-Oct;2(5):S23-6.
The 5-year survival rate of early gastric cancer (EGC) is 85-100% after "curative" resection, as compared to 20-30% in advanced gastric cancer (AGC). Because of this relatively high cure rate, the interest in the diagnosis and therapy of EGC has been steadily increasing. The present study, based on 60 EGCs, in a single-institution, is aimed at critical evaluating the diagnostic procedures and surgical options.
Sixty patients with early gastric cancer (36 men and 24 women; median age, 61 years; range, 28-84) were diagnosed and operated on. They represented 21% of all patients with gastric cancer (281) treated in the period January 1987 to December 2001. The most frequent symptom was epigastric pain (84%). Barium upper gastrointestinal radiography findings were strongly suggestive of malignancy in 56 cases (93%). Preoperative histopathological diagnosis of adenocarcinoma was performed in 57 cases (95%). In 3 cases (5%) severe epithelial dysplasia (associated with ulcer) was the first diagnosis, but the final diagnosis, on the basis of resected specimens, was well differentiated adenocarcinoma. The primary surgical procedure included: a) subtotal distal resection (49 cases); b) total gastrectomy (6) for proximal neoplastic extension; c) proximal gastric resection (2) for cardial cancer; d) degastro-total gastrectomy (3) for cancer of the stump. Two patients, previously treated with conservative surgery, underwent degastro-total gastrectomy for neoplastic microfocal extension to the resection margin and for early anastomotic recurrence, respectively. Mural infiltration was limited to the mucosa and submucosa in 36 and 24 cases, respectively. Lymph node metastases were found in 3 mucosal and 9 submucosal tumor cases, involving either the first and second echelon. No operative deaths or postsurgical complications occurred in this series. In the follow-up period (median, 63 months; range, 3-178) 7 patients died due to other causes; 1 developed liver metastases, another developed oropharyngeal cancer and 2 died of biopsy-proven lung cancer without evidence of recurrent or metastatic gastric cancer.
The clinical presentation of EGC is aspecific. Preoperative endoscopy with multiple biopsies remains the most sensitive diagnostic procedure. For treatment, subtotal distal gastric resection with lymphadenectomy is the gold standard, but in some instances total gastrectomy may be indicated. Accurate pathological examination establishes the depth of infiltration, as well as the superficial extension of tumors and lymph node status. Although the prognosis of EGC is favorable, a medium-term follow-up should be planned.
早期胃癌（EGC）“根治性”切除术后5年生存率为85 - 100%，而进展期胃癌（AGC）为20 - 30%。由于治愈率相对较高，对EGC诊断和治疗的关注度一直在稳步上升。本研究基于单机构的60例EGC病例，旨在严格评估诊断程序和手术选择。
60例早期胃癌患者（男性36例，女性24例；中位年龄61岁；范围28 - 84岁）被诊断并接受手术。他们占1987年1月至2001年12月期间所有胃癌患者（281例）的21%。最常见症状是上腹部疼痛（84%）。上消化道钡餐造影检查结果在56例（93%）中强烈提示恶性肿瘤。57例（95%）术前进行了腺癌的组织病理学诊断。3例（5%）最初诊断为重度上皮发育异常（伴溃疡），但根据切除标本最终诊断为高分化腺癌。主要手术方式包括：a）远端次全切除术（49例）；b）因肿瘤近端侵犯行全胃切除术（6例）；c）因贲门癌行近端胃切除术（2例）；d）因残端癌行胃次全胃切除术（3例）。2例先前接受保守手术的患者，分别因肿瘤微灶侵犯至切除边缘和早期吻合口复发而接受胃次全胃切除术。36例和24例的肌层浸润分别局限于黏膜和黏膜下层。3例黏膜层和9例黏膜下层肿瘤病例发现有淋巴结转移，累及第一和第二站。本系列中无手术死亡或术后并发症发生。在随访期（中位时间63个月；范围3 - 178个月），7例患者因其他原因死亡；1例发生肝转移，另1例发生口咽癌，2例死于经活检证实的肺癌，无复发性或转移性胃癌证据。
EGC的临床表现不具特异性。术前多次活检的内镜检查仍是最敏感的诊断方法。对于治疗，远端胃次全切除术加淋巴结清扫是金标准，但在某些情况下可能需要行全胃切除术。准确的病理检查可确定浸润深度、肿瘤的浅表范围以及淋巴结状态。尽管EGC的预后良好，但应计划进行中期随访。
