Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Suite T2-60, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
Gastric Cancer. 2012 Sep;15 Suppl 1:S100-7. doi: 10.1007/s10120-011-0074-9. Epub 2011 Jul 23.
The overall prognosis and survival of patients with advanced gastric cancer is generally poor. One of the most powerful predictors of outcomes in gastric cancer surgery is an R0 resection. However, the extent of the required surgical resection and the additional benefit of multivisceral resection (MVR) are controversial.
Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers.
Seventeen studies were included in this review. Among the 1343 patients who underwent MVR, overall complication rates ranged from 11.8 to 90.5%. Perioperative mortality was found to be 0-15%. Pathological T4 disease was confirmed in 28.8-89% of patients. R0 resection and extent of nodal involvement were important predictors of survival in patients undergoing MVR. Patient outcomes may also be affected by the number of organs resected.
Gastrectomy with MVR can be safely pursued in patients with locally advanced gastric cancer to achieve an R0 resection. MVR may not be beneficial in patients with extensive nodal disease.
晚期胃癌患者的整体预后和生存率普遍较差。胃癌手术结果的最有力预测因素之一是 R0 切除。然而，手术切除的范围和多脏器切除（MVR）的额外益处存在争议。
使用 Medline、EMBASE 和 Cochrane 对照试验中心注册库，从 1998 年 1 月 1 日至 2009 年 12 月 31 日进行电子文献检索。由至少两名评审员独立对所有搜索标题和摘要进行相关性评价。
本综述纳入了 17 项研究。在接受 MVR 的 1343 例患者中，总体并发症发生率为 11.8%至 90.5%。围手术期死亡率为 0-15%。病理 T4 期疾病在 28.8%至 89%的患者中得到证实。R0 切除和淋巴结受累范围是接受 MVR 的患者生存的重要预测因素。患者的预后也可能受到切除器官数量的影响。
对于局部晚期胃癌患者，MVR 胃切除术可以安全进行，以达到 R0 切除。对于广泛淋巴结疾病的患者，MVR 可能没有益处。
