Kinoshita T, Maruyama K, Sasako M, Okabayashi K
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1992 Feb;93(2):128-32.
From 1977 to 1988, four hundred and sixty-five patients received total or proximal gastrectomy for advanced gastric cancer without leaving a tumor mass at National Cancer Center Hospital. Of these, 182 patients received distal pancreatectomy (PS) and 123 received pancreas-preserving operation with removal of the splenic artery (PP). The 5-year survival rate for the PS group (32.0%) was significantly lower than 61.0% for the PP group. Concerning grades of cancer stage, the 5-year survival rates for the PP group were better than those for the PS group in stages 1, 2 and 3. Seventy-four of the 465 patients were found to have histologically proven metastatic nodes around the splenic artery. Their 5-year survival rates were 9.2% for the PS group (n = 46) and 32.7% for the PP group (n = 13) respectively. Considering the difference in the background factors, these data suggest the effectiveness of the pancreas-preserving operation for advanced gastric cancer even with microscopic lymph node metastasis around the splenic artery. The pancreas-preserving operation with removal of the splenic artery might be indicated for the patient without definite macroscopically metastatic lymph node around the splenic artery.
1977年至1988年期间，465例晚期胃癌患者在国立癌症中心医院接受了全胃或近端胃切除术，术中均未残留肿瘤。其中，182例患者接受了远端胰腺切除术（PS），123例患者接受了保留胰腺并切除脾动脉的手术（PP）。PS组的5年生存率（32.0%）显著低于PP组的61.0%。关于癌症分期，PP组在1、2和3期的5年生存率均优于PS组。465例患者中有74例经组织学证实脾动脉周围有转移淋巴结。PS组（n = 46）的5年生存率为9.2%，PP组（n = 13）的5年生存率为32.7%。考虑到背景因素的差异，这些数据表明，即使对于脾动脉周围有微小淋巴结转移的晚期胃癌患者，保留胰腺的手术也是有效的。对于脾动脉周围无明确肉眼可见转移淋巴结的患者，可能适合进行保留胰腺并切除脾动脉的手术。
