Department of Surgery Oncology, General Surgery, First Hospital of China Medical University, Shenyang, China.
BMC Cancer. 2010 Jun 20;10:308. doi: 10.1186/1471-2407-10-308.
We conducted a retrospective study in our hospital in which we compared D1 with D3 through D2 lymphadenectomy for gastric cancer in terms of morbidity, postoperative mortality, long-term survival after surgery.
567 patients who were performed curative intent between 1980 and 2003 were enrolled. 187 in the D1 group, 189 in the D2 group and 191 in the D3 group. Every procedure was verified by pathological analyses. The primary endpoints were 5-year overall survival.
Median follow-up periods were 36 months and 60 months for D1 group and D3 group. Overall 5-year survival rate was significantly higher in patients underwent D3 surgery than in those performed D1 surgery (37.4% vs 48.7%; log-rank, p = 0.027). For the cases followed up to 120 months, the 10-year overall survival rate was 29% (95% CI, 22.1% to 35.9%) for the D1 group and 33.7% (95% CI, 26.6% to 40.8%) for the D3 group (log-rank, p = 0.005).
D1 surgery should be operated only for patients with Borrmann I disease. As D3 gastrectomy is associated with low mortality and adequate survival times when performed in selected institutions that have had sufficient experience with the operation and with postoperative management, we recommend D3 lymphadenectomy for patients with curable gastric cancer.
我们在我院进行了一项回顾性研究，比较了胃癌 D1 与 D3 至 D2 淋巴结清扫术的发病率、术后死亡率和手术切除后的长期生存情况。
共纳入 1980 年至 2003 年间行根治性手术的 567 例患者，其中 D1 组 187 例，D2 组 189 例，D3 组 191 例。所有手术均经病理分析验证。主要终点为 5 年总生存率。
D1 组和 D3 组的中位随访时间分别为 36 个月和 60 个月。D3 手术患者的 5 年总生存率明显高于 D1 手术患者（37.4% vs 48.7%；log-rank，p = 0.027）。对于随访至 120 个月的病例，D1 组的 10 年总生存率为 29%（95%CI，22.1%至 35.9%），D3 组为 33.7%（95%CI，26.6%至 40.8%）（log-rank，p = 0.005）。
D1 手术仅适用于 Borrmann I 型疾病患者。由于 D3 胃切除术死亡率低，且在具有足够手术经验和术后管理经验的选定机构中生存时间足够，因此我们建议对可治愈的胃癌患者行 D3 淋巴结清扫术。
Zotero 插件