Díaz de Liaño Alvaro, Yárnoz Concepción, Aguilar Rubén, Artieda Cristina, Ortiz Héctor
Sección Esófago-Gástrica, Servicio de Cirugía General, Hospital Virgen del Camino, Pamplona, Navarra, España.
Cir Esp. 2008 Jan;83(1):18-23. doi: 10.1016/s0009-739x(08)70491-3.
The combination of gastrectomy and D2 lymphadenectomy is still not a widely accepted therapeutic option by Western surgeons, due to its high post-operative morbidity and mortality.
To evaluate the morbidity and mortality in a series of patients with gastric cancer treated by gastrectomy and D2 lymphadenectomy, and compare these results with those published by centres with notable experience.
A descriptive and prospective study on a series of 126 consecutive patients with gastric cancer treated by gastrectomy and D2 lymphadenectomy. All complications were recorded, grouped into abdominal and non-abdominal, as well as surgical re-interventions.
Total gastrectomy was performed on 95 (75.4%) of the 126 patients. It was combined with splenectomy in 22 cases (17.5%) and left pancreatectomy in 9 (7.1%). The stages, according to the AJCC, were: stage 0: 4.8%, IA: 17.5%, IB: 22.2%, II: 10.3%, IIIA: 16.7%, IIIB: 9.5%, and stage IV: 19%. Of these patients 52.4% were overweight and more than 60% had an ASA risk assessment of III or IV. Fifty complications arose in 37 (29%) of the 26 patients, which required 12 surgical re-interventions (all in total gastrectomy cases). Four anastomosis dehiscence were diagnosed and 4 intra-abdominal abscesses with no evidence of anastomosis dehiscence which were resolved with drainage. Two (1.6%) of the 126 patients died, both after total gastrectomy and with no evidence of intra-abdominal complications.
Patients with gastric cancer, even with associated risk factors, can be treated by gastrectomy and D2 lymphadenectomy with similar morbidity and mortality rates to those centres with more experience, due to a great extent to sub-specialising in this surgery.
由于胃切除术联合D2淋巴结清扫术术后发病率和死亡率较高，西方外科医生仍未广泛接受这一治疗方案。
评估一系列接受胃切除术联合D2淋巴结清扫术的胃癌患者的发病率和死亡率，并将这些结果与经验丰富的中心所发表的结果进行比较。
对一系列连续的126例接受胃切除术联合D2淋巴结清扫术的胃癌患者进行描述性前瞻性研究。记录所有并发症，分为腹部和非腹部并发症，以及手术再次干预情况。
126例患者中有95例（75.4%）接受了全胃切除术。其中22例（17.5%）联合脾切除术，9例（7.1%）联合左胰腺切除术。根据美国癌症联合委员会（AJCC）的分期：0期：4.8%，IA期：17.5%，IB期：22.2%，II期：10.3%，IIIA期：16.7%，IIIB期：9.5%，IV期：19%。这些患者中52.4%超重，超过60%的美国麻醉医师协会（ASA）风险评估为III或IV级。26例患者中有37例（29%）出现50种并发症，其中12例需要手术再次干预（均为全胃切除术病例）。诊断出4例吻合口裂开，4例腹腔内脓肿，无吻合口裂开证据，经引流后治愈。126例患者中有2例（1.6%）死亡，均为全胃切除术后，且无腹腔内并发症证据。
胃癌患者，即使伴有相关危险因素，也可接受胃切除术联合D2淋巴结清扫术，其发病率和死亡率与经验更丰富的中心相似，这在很大程度上得益于该手术的亚专业化。
