Yoshiyuki Ikeda, Tatsuo Kanda, Shin-ichi Kosugi, Kazuhito Yajima, Atsushi Matsuki, Katsuyoshi Hatakeyama, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.
World J Gastrointest Surg. 2009 Nov 30;1(1):49-55. doi: 10.4240/wjgs.v1.i1.49.
To elucidate the influence of liver cirrhosis (LC) on the prognosis of patients with gastric cancer (GC).
Of the 1347 GC patients who underwent curative gastrectomy for GC between January 1984 and June 2007, 25 patients (21 men and 4 women with a median age of 67 years; range 54-77 years) with LC were enrolled in this study. Using the Child-Pugh classification, 15 patients were evaluated as grade A and 10 patients as grade B. No grade C patient underwent gastrectomy in this series. Clinical outcomes, including postoperative morbidity and survival, were retrospectively analyzed based on medical records and surgical files.
There was no significant difference in operative blood loss and perioperative blood transfusion between the two groups. The most common postoperative complication was intractable ascites, which was the single postoperative morbidity noted more frequently in grade B patients (40.0%) than in grade A patients (6.7%) with statistical significance (P = 0.041). Operative mortality due to hepatic failure was seen in one grade A patient. Three patients had hepatocellular carcinoma (HCC) at presentation and two patients developed HCC after surgery. Overall 5-year survival rate was 58.9% in patients with early GC and 33.3% in patients with advanced GC (P = 0.230). GC-specific 5-year survival rate of early GC patients was 90.0% while that of advanced GC patients was 58.3% (P = 0.010). Four patients with early GC died of uncontrolled HCC, of which two were synchronous and two metachronous.
The risk of postoperative intractable ascites is high, particularly in grade B patients. Early detection and complete control of HCC is vital to improve a patient's prognosis.
阐明肝硬化（LC）对胃癌（GC）患者预后的影响。
本研究纳入了 1984 年 1 月至 2007 年 6 月间接受根治性胃切除术治疗 GC 的 1347 例 GC 患者，其中 25 例（21 例男性，4 例女性；中位年龄 67 岁；范围 54-77 岁）患有 LC。根据 Child-Pugh 分级，15 例患者评为 A 级，10 例患者评为 B 级。本系列中无 C 级患者接受胃切除术。基于病历和手术档案，回顾性分析了包括术后发病率和生存在内的临床结局。
两组间手术失血量和围手术期输血无显著差异。最常见的术后并发症是难治性腹水，B 级患者（40.0%）比 A 级患者（6.7%）更常见，具有统计学意义（P=0.041）。1 例 A 级患者因肝功能衰竭而死亡。3 例患者就诊时即患有肝细胞癌（HCC），2 例患者术后发生 HCC。早期 GC 患者的 5 年总生存率为 58.9%，晚期 GC 患者为 33.3%（P=0.230）。早期 GC 患者的 GC 特异性 5 年生存率为 90.0%，而晚期 GC 患者为 58.3%（P=0.010）。4 例早期 GC 患者死于无法控制的 HCC，其中 2 例为同时性，2 例为异时性。
术后难治性腹水风险较高，特别是 B 级患者。早期发现并完全控制 HCC 对改善患者预后至关重要。
