Takiguchi Shuji, Masuzawa Toru, Hirao Motohiro, Imamura Hiroshi, Kimura Yutaka, Fujita Junya, Tamura Shigeyuki, Fujiwara Yoshiyuki, Mori Masaki, Doki Yuichiro
Osaka University Graduate School of Medicine, Department of Gastroenterological Surgery, Osaka, Japan.
Hepatogastroenterology. 2011 Sep-Oct;58(110-111):1823-7. doi: 10.5754/hge11161. Epub 2011 Jul 15.
BACKGROUND/AIMS: Various surgical treatments are indicated for early gastric cancers in upper third of the stomach (U-EGC) because of its anatomical property and favorable prognosis.
Five hundred and eighty six cases of U-EGCs were collected for 9 years from 19 hospitals in Japan. Surgical procedures were classified as total (TG) and proximal gastrectomy (PG), and the latter was subclassified as esophagogastrostomy (PG-EG) and jejunal interposition (PG-JI) reconstruction.
TG was more frequent than PG (76.3% vs. 21.8%, p<0.0001). PG was more frequently performed in high volume hospitals than in low volume hospitals (26.8% vs. 10.2%, p<0.0001), however there were still large difference in frequency of PG even among high volume hospitals, ranging from 5.0% to 72.0%. For reconstruction after PG, PG-EG and PG-JI were representatively performed in 50 (39.1%) and 35 (27.3%) patients. Each institute tended to preferentially employ either PG-EG or PG-JI. Tumor size was significantly larger in TG than in PG (38.8mm vs. 22.3mm, p<0.0001) and diffuse type tended to be more frequent in TG as well.
There is a huge variety of surgical treatment for U-ECG in general hospitals in our country. A multi-institutional large cohort randomized trial might be urgent to establish the standard surgical procedure of this infrequent disease.
背景/目的：由于胃上部早期胃癌（U-EGC）的解剖学特性及良好预后，针对其有多种手术治疗方式。
从日本19家医院收集了9年间586例U-EGC病例。手术方式分为全胃切除术（TG）和近端胃切除术（PG），后者又细分为食管胃吻合术（PG-EG）和空肠间置术（PG-JI）重建。
TG比PG更常见（76.3%对21.8%，p<0.0001）。PG在高容量医院比在低容量医院更常施行（26.8%对10.2%，p<0.0001），然而即使在高容量医院之间，PG的施行频率仍有很大差异，范围从5.0%到72.0%。对于PG后的重建，PG-EG和PG-JI分别在50例（39.1%）和35例（27.3%）患者中施行。每个机构倾向于优先采用PG-EG或PG-JI。TG组的肿瘤大小显著大于PG组（38.8mm对22.3mm，p<0.0001），弥漫型在TG组也更常见。
我国综合医院对U-ECG的手术治疗方式繁多。开展多机构大样本队列随机试验对于确立这种罕见疾病的标准手术方式可能刻不容缓。
