Hiki Naoki, Sano Takeshi, Fukunaga Tetsu, Ohyama Shigekazu, Tokunaga Masanori, Yamaguchi Toshiharu
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
J Am Coll Surg. 2009 Sep;209(3):297-301. doi: 10.1016/j.jamcollsurg.2009.05.027. Epub 2009 Jul 24.
Pylorus-preserving gastrectomy (PPG) is performed in some patients for the treatment of early gastric cancer. The aim of this study was to investigate longterm survival for patients having PPG with extensive lymph node dissection, except for the suprapyloric nodes, for early gastric cancer.
From January 1995 to December 2006, 305 patients underwent PPG if they met the following criteria: cT1 (mucosa or submucosa), cN0 gastric cancer in the middle body of the stomach. Overall 5-year survival, cancer-related mortality, and freedom from recurrence were assessed retrospectively.
The median followup period was 61 months (range 27 to 144 months). Seven patients died, and the overall 5-year survival probability was 98%. Gastric cancer-related mortality was 0% and none of the patients had evidence of tumor recurrence. The accuracy of the preoperative diagnosis of T1 gastric cancer using endoscopy or endoscopic ultrasonography was 95.7%.
PPG may provide a longterm survival benefit for patients with clinically diagnosed T1 (mucosa or submucosa), cN0 gastric cancer in the middle body of the stomach, only when the accuracy of preoperative diagnosis can be assured.
对于部分早期胃癌患者，需实施保留幽门的胃切除术（PPG）。本研究旨在探讨早期胃癌患者接受除幽门上淋巴结外的广泛淋巴结清扫的PPG后的长期生存率。
1995年1月至2006年12月期间，305例符合以下标准的患者接受了PPG：胃中部cT1（黏膜或黏膜下层）、cN0期胃癌。对总体5年生存率、癌症相关死亡率和无复发生存率进行回顾性评估。
中位随访期为61个月（范围27至144个月）。7例患者死亡，总体5年生存概率为98%。胃癌相关死亡率为0%，且无患者有肿瘤复发迹象。使用内镜或内镜超声对T1期胃癌进行术前诊断的准确率为95.7%。
仅当术前诊断准确率能够得到保证时，PPG可能为临床诊断为胃中部T1（黏膜或黏膜下层）、cN0期胃癌的患者提供长期生存获益。
