Nashimoto Atsushi, Yabusaki Hiroshi, Nakagawa Satoru
Division of Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
Nihon Geka Gakkai Zasshi. 2007 May;108(3):120-4.
Recurrence patterns after curative gastrectomy and follow-up surveillance were studied by referring to the literature. An analysis was done of 151 (11.5%) recurrent patients among 1,323 primary gastric cancer patients after curative (R0) resection. The recurrence rate was hematologic in 43%, peritoneal in 32.5%, and remote lymph node in 22.5%, although peritoneal recurrence was the most frequent in references. There were many peritoneal and remote lymph node recurrences in undifferentiated adenocarcinoma and hematologic recurrence in differentiated adenocarcinoma. In pT1, the hematologic recurrence rate was 90% and lymph node recurrence rate was 10%, which occurred even after 5 years. The frequency of peritoneal recurrence increased markedly in pT3. The rate of recurrence was 74.1% within 2 years and 88.1% within 3 years. There was no difference between lymph node, hematologic, and peritoneal recurrence in terms of survival time after surgery or even after recurrence. Referring to these results, follow-up surveillance programs for early and advanced gastric caner were developed. Surveillance will be continued for 10 years after surgery and mass survey or complete medical checkup is recommended 5 years after surgery. A standard follow-up program should exist, although it is not necessary for it to be the same in different institutes. There is as yet no consensus regarding intensive follow-up after curative gastrectomy because the evidence of efficacy is weak. In conclusion, a randomized, controlled trial of intensive follow-up is required to demonstrate the survival effect of surveillance.
通过查阅文献，研究了根治性胃切除术后的复发模式及随访监测情况。对1323例接受根治性（R0）切除的原发性胃癌患者中的151例（11.5%）复发患者进行了分析。复发率血液学复发占43%，腹膜复发占32.5%，远处淋巴结复发占22.5%，尽管在参考文献中腹膜复发最为常见。未分化腺癌多为腹膜和远处淋巴结复发，分化型腺癌多为血液学复发。在pT1期，血液学复发率为90%，淋巴结复发率为10%，甚至在5年后仍有发生。pT3期腹膜复发频率明显增加。2年内复发率为74.1%，3年内复发率为88.1%。手术或复发后的生存时间在淋巴结、血液学和腹膜复发方面没有差异。参照这些结果，制定了早期和进展期胃癌的随访监测方案。术后将持续监测10年，建议术后5年进行大规模调查或全面体检。应存在一个标准的随访方案，尽管不同机构不必相同。对于根治性胃切除术后的强化随访尚无共识，因为疗效证据不足。总之，需要进行一项强化随访的随机对照试验来证明监测的生存效果。
