Custureri Filippo, D'Orazi Valerio, Peparini Nadia, Gabatel Riccardo, Urciuoli Paolo, Patrizi Gregorio, Redler Adriano, Di Matteo Giorgio
Department of Surgical Sciences La Sapienza University, Rome, Italy.
Hepatogastroenterology. 2004 Jul-Aug;51(58):1210-4.
BACKGROUND/AIMS: The authors report their experience in choosing the surgical treatment for early gastric cancer.
A retrospective study was conducted to examine the long-term outcome of 18 patients with early gastric cancer (10%) on a series of 180 patients treated for gastric carcinoma by the same surgical équipe from January 1986 to June 1997. Radical surgery with gastrectomy and extended lymphadenectomy ("regional" from 1986 to 1991; D2 from 1992 to 1997) was chosen as standard treatment for early gastric cancer except in elderly or high-risk patients and in cases of mucosal tumors diagnosed at definitive histology after surgery for benign diseases in which limited surgery was performed.
All patients received curative (R0) surgery. One patient with mucosal-N1 tumor and another one with submucosal-N0 tumor died because of gastric cancer at 51 and 42 postoperative months respectively. The mean follow-up time was 99.8 (11-193) months. The overall 5-year and 10-year survival rates are 86.7% and 86.7% respectively. The 5- and 10-year survival rates for intramucosal tumors are 91% and 91% respectively and for submucosal cancer are 75% and 75% (P=0.39).
According to the prognostic value of nodal involvement and the difficulty in achieving a preoperative accurate diagnosis of depth of invasion and of nodal involvement in early gastric cancer, a radical gastric resection with D2-lymphadenectomy should be performed.
背景/目的：作者报告其在早期胃癌手术治疗选择方面的经验。
进行一项回顾性研究，以检查1986年1月至1997年6月间由同一手术团队治疗的180例胃癌患者中18例（10%）早期胃癌患者的长期结局。除老年或高危患者以及良性疾病手术后经最终组织学诊断为黏膜肿瘤且行有限手术的病例外，根治性胃切除术及扩大淋巴结清扫术（1986年至1991年为“区域性”；1992年至1997年为D2）被选为早期胃癌的标准治疗方法。
所有患者均接受了根治性（R0）手术。1例黏膜-N1肿瘤患者和另1例黏膜下-N0肿瘤患者分别在术后51个月和42个月死于胃癌。平均随访时间为99.8（11 - 193）个月。总体5年和10年生存率分别为86.7%和86.7%。黏膜内肿瘤的5年和10年生存率分别为91%和91%，黏膜下癌的5年和10年生存率分别为75%和75%（P = 0.39）。
根据淋巴结受累的预后价值以及早期胃癌术前准确诊断浸润深度和淋巴结受累情况的难度，应行D2淋巴结清扫的根治性胃切除术。
