Borie F, Plaisant N, Millat B, Hay J M, Fagniez P L
Service Chirirgie Digestive A, Hôpital St Eloi, Montpellier, France.
Ann Surg Oncol. 2004 May;11(5):512-7. doi: 10.1245/ASO.2004.06.025. Epub 2004 Apr 12.
The extent of lymphadenectomy (limited vs. extended) and that of gastric resection (partial vs. total) remain controversial issues in the management of early gastric cancer (EGC). A multicentric study was performed to elucidate the appropriate gastric resection with lymph node dissection for early gastric cancer.
From 1979 to 1988, 332 patients with EGC underwent surgery in 23 French centers. Clinicopathological data, the extent of resection, and the number of lymph nodes retrieved were reviewed retrospectively and screened for prognostic effect. The mean follow-up for the 332 EGC patients was 80 months.
Postoperative mortality was correlated to age (odds ratio [OR], 1.1) and extent of gastric resection (OR,10.3). Examination of survival data (excluding postoperative deaths) with univariate analysis and the Cox proportional hazards model showed that the independent factors for excellent prognosis included no lymphatic involvement (P =.005), 10 or more lymph nodes retrieved (P =.003), site of the tumor in the lower third of the stomach (P =.01), and mucosal lesions (P =.04). The extent of resection did not influence long-term survival.
Our results suggest that because of the associated good prognosis, the appropriate surgical treatment for EGC is partial gastrectomy with lymphadenectomy retrieving 10 or more lymph nodes.
在早期胃癌（EGC）的治疗中，淋巴结清扫范围（有限清扫与扩大清扫）和胃切除范围（部分切除与全胃切除）仍是存在争议的问题。开展了一项多中心研究以阐明早期胃癌合适的胃切除联合淋巴结清扫术式。
1979年至1988年，23个法国中心的332例早期胃癌患者接受了手术。回顾性分析临床病理数据、切除范围及获取的淋巴结数量，并筛选其预后影响因素。332例早期胃癌患者的平均随访时间为80个月。
术后死亡率与年龄（比值比[OR]，1.1）和胃切除范围（OR，10.3）相关。单因素分析及Cox比例风险模型对生存数据（不包括术后死亡病例）的分析显示，预后良好的独立因素包括无淋巴转移（P = 0.005）、获取10个或更多淋巴结（P = 0.003）、肿瘤位于胃下三分之一（P = 0.01）及黏膜病变（P = 0.04）。切除范围不影响长期生存。
我们的结果表明，鉴于早期胃癌相关的良好预后，合适的手术治疗方式是行部分胃切除联合淋巴结清扫术，且获取10个或更多淋巴结。
