Oñate-Ocaña Luis F, Méndez-Cruz Guadalupe, Hernández-Ramos Roberto, Becker Mauricio, Carrillo José F, Herrera-Goepfert Roberto, Aiello-Crocifoglio Vincenzo, Ochoa-Carrillo Francisco, Beltrán-Ortega Arturo
Clinica de Neoplasias Gástricas, Departamento de Gastroenterología, Instituto Nacional de Cancerología, San Fernando 22, Colonia Sección XVI, Tlalpan, D.F., 14080, Mexico City, Mexico.
Gastric Cancer. 2007;10(4):215-20. doi: 10.1007/s10120-007-0437-4. Epub 2007 Dec 25.
Indications for palliative surgery in gastric carcinoma (GC) are controversial. Our aim was to describe the results of palliative surgery in GC in terms of operative morbidity and survival.
We conducted a retrospective cohort study of patients with GC, who were divided into three groups: resection with microscopic residual disease (R1), palliative resection with macroscopic residual disease (R2), and gastrojejunostomy. Comparisons were tested with analysis of variance (ANOVA) or chi(2) test, and the Kaplan-Meier method was used for survival analysis.
One hundred and thirty-two patients were included in the study: 21 had R1, 71 had R2, and 40 had gastrojejunostomy. Surgical morbidity was recorded in 4 patients (19%), 23 patients (32.4%), and 1 patient (2.5%) in each of the three groups, respectively (P = 0.001). Operative mortality occurred in 6 patients (8.5%) from the R2 group and in 1 (2.5%) patient from the gastrojejunostomy group (P = 0.406). Median survivals of the R1, R2, and gastrojejunostomy groups were 22.8 months (95% confidence interval [CI], 16.4-29.3), 12.4 (95% CI, 9.01-15.8) months, and 6.4 months (95% CI, 0-14.6), respectively (P = 0.078)
R1 resections and gastrojejunostomy were associated with low surgical morbidity and mortality, unlike R2 resection; in this group, surgical morbidity and mortality was high. Therefore, the benefit of palliative resection in the presence of extensive residual disease should be balanced against the risk of surgical morbidity.
胃癌姑息性手术的指征存在争议。我们的目的是从手术并发症和生存率方面描述胃癌姑息性手术的结果。
我们对胃癌患者进行了一项回顾性队列研究，将患者分为三组：有镜下残留病灶的切除术（R1）、有肉眼残留病灶的姑息性切除术（R2）和胃空肠吻合术。采用方差分析（ANOVA）或卡方检验进行比较，并使用Kaplan-Meier方法进行生存分析。
132例患者纳入研究：21例为R1，71例为R2，40例为胃空肠吻合术。三组患者的手术并发症分别为4例（19%）、23例（32.4%）和1例（2.5%）（P = 0.001）。R2组有6例患者（8.5%）发生手术死亡，胃空肠吻合术组有1例患者（2.5%）发生手术死亡（P = 0.406）。R1组、R2组和胃空肠吻合术组的中位生存期分别为22.8个月（95%置信区间[CI]，16.4 - 29.3）、12.4个月（95% CI，9.01 - 15.8）和6.4个月（95% CI，0 - 14.6）（P = 0.078）。
与R2切除术不同，R1切除术和胃空肠吻合术的手术并发症和死亡率较低；在R2组中，手术并发症和死亡率较高。因此，存在广泛残留病灶时姑息性切除术的益处应与手术并发症风险相权衡。
