Ogoshi Kyoji, Okamoto Yuichi, Nabeshima Kazuhito, Morita Mari, Nakamura Kenji, Iwata Kunihiro, Soeda Jinichi, Kondoh Yasumasa, Makuuchi Hiroyasu
Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan.
Digestion. 2005;71(4):213-24. doi: 10.1159/000087046. Epub 2004 Sep 6.
To assess the roles of the extent of gastric resection and duodenal food passage reconstruction in gastric cancer, we examined a consecutive series of 1,061 patients who underwent total or partial (proximal and distal) gastrectomies with or without duodenal food passage reconstruction between August of 1974 and January of 2002, and received gastrectomies with D2-3 lymph node dissection. Patients who underwent distal or proximal gastrectomy were found to have significantly better survival rates than those who underwent total gastrectomy in stages 1A (10-year survival: 86.6 and 78.9 vs. 61.6%), 2 (56.5 and 65.6 vs. 34.4%), 3A (45.9 and 33.3 vs. 15.2%), and 4 (5-year survival rates: 23.7 and 50.0 vs. 7.1%). Additionally, patients with duodenal food passage reconstruction or double tract reconstruction also showed significantly better survival rates than those without duodenal food reconstruction in stages 1A (10-year survival: 86.4 and 82.5 vs. 61.7%), 1B (69.9 and 90.6 vs. 54.1%), 2 (60.5 and 63.3 vs. 16.5%), and 3A (39.9 and 47.4 vs. 23.1%). In multivariate analysis, the independent prognostic factors were age at operation, depth of tumor, duodenal food passage reconstruction, and lymph node metastasis. Our results indicate that both the extent of gastric resection and duodenal food passage reconstruction were important factors in the outcome of gastric cancer patients, and that surgeons should perform minimal gastric resection with preservation of the duodenal food passage when the gastric stump is tumor-free.
为评估胃癌胃切除范围及十二指肠食物通道重建的作用，我们对1974年8月至2002年1月期间连续收治的1061例行全胃或部分（近端和远端）胃切除术（伴或不伴十二指肠食物通道重建）且行D2-3淋巴结清扫的患者进行了研究。结果发现，在1A期（10年生存率：86.6%和78.9% vs. 61.6%）、2期（56.5%和65.6% vs. 34.4%）、3A期（45.9%和33.3% vs. 15.2%）和4期（5年生存率：23.7%和50.0% vs. 7.1%），行远端或近端胃切除术的患者生存率显著高于行全胃切除术的患者。此外，在1A期（10年生存率：86.4%和82.5% vs. 61.7%）、1B期（69.9%和90.6% vs. 54.1%）、2期（60.5%和63.3% vs. 16.5%）和3A期（39.9%和47.4% vs. 23.1%），行十二指肠食物通道重建或双通道重建的患者生存率也显著高于未行十二指肠食物通道重建的患者。多因素分析显示，独立的预后因素为手术年龄、肿瘤深度、十二指肠食物通道重建及淋巴结转移。我们的结果表明，胃切除范围和十二指肠食物通道重建均是影响胃癌患者预后的重要因素，并且当胃残端无肿瘤时，外科医生应行最小范围的胃切除并保留十二指肠食物通道。
