腹腔镜辅助胃癌根治术治疗进展期胃癌的长期疗效：一项大规模多中心回顾性研究。
Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study.
机构信息
Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Seongnam-si, Korea.
出版信息
Surg Endosc. 2012 Jun;26(6):1548-53. doi: 10.1007/s00464-011-2065-7. Epub 2011 Dec 15.
BACKGROUND
Recently, the number of laparoscopic procedures for gastric cancer has increased rapidly. Laparoscopic surgery is reported to have many advantages over open gastrectomy with oncologic safety in early gastric cancer. However, there were few reports on long-term outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC). The aim of this study was to investigate long-term survival outcomes after LAG for AGC.
METHODS
The data of 1,485 patients who underwent LAG between April 1998 and December 2005 by ten surgeons at ten hospitals were collected retrospectively. Among them, 239 patients who were diagnosed with AGC on final pathologic examination were enrolled in the present study to investigate long-term clinical outcomes.
RESULTS
The ratio of male to female patients was 151:88 and the mean age was 57.1 years. One hundred ninety-three subtotal gastrectomies, 41 total gastrectomies, and 5 proximal gastrectomies were performed. D1 + α, D1 + β, and D2 lymph node dissections were performed for 14, 62, and 163 cases, respectively. The median follow-up period was 55.4 months. The overall 5-year survival rate of the 239 AGC patients was 78.8% and the disease-specific 5-year survival rate was 85.6%. The 5-year survival rates of the TNM staging system's (7th ed.) stages were 90.5% (stage Ib, n = 86), 86.4% (stage IIa, n = 53), 78.3% (stage IIb, n = 44), 52.8% (stage IIIa, n = 24), 52.9% (stage IIIb, n = 24), and 37.5% (stage IIIc, n = 8) (p < 0.001).
CONCLUSION
The long-term survival outcome rates of LAG for AGC in the present study were comparable to those previously reported for open gastrectomy. Based on the present results, a well-designed phase III trial comparing LAG and open gastrectomy for AGC will be needed to affirm the validity of LAG for AGC.
背景
最近，腹腔镜胃癌手术的数量迅速增加。与早期胃癌的开放性胃切除术相比，腹腔镜手术具有许多优势，并且具有肿瘤安全性。然而，有关腹腔镜辅助胃切除术（LAG）治疗进展期胃癌（AGC）的长期结果的报道很少。本研究旨在探讨 LAG 治疗 AGC 的长期生存结果。
方法
回顾性收集了 1998 年 4 月至 2005 年 12 月 10 家医院的 10 位外科医生进行的 1485 例 LAG 患者的数据。其中，239 例患者在最终病理检查中被诊断为 AGC，纳入本研究以调查长期临床结果。
结果
患者中男女比例为 151:88，平均年龄为 57.1 岁。行全胃切除术 41 例，近端胃切除术 5 例，胃大部切除术 193 例。D1 + α、D1 + β 和 D2 淋巴结清扫术分别用于 14、62 和 163 例患者。中位随访时间为 55.4 个月。239 例 AGC 患者的总 5 年生存率为 78.8%，疾病特异性 5 年生存率为 85.6%。第 7 版 TNM 分期系统（7th ed.）各期的 5 年生存率分别为 90.5%（Ib 期，n=86），86.4%（IIa 期，n=53），78.3%（IIb 期，n=44），52.8%（IIIa 期，n=24），52.9%（IIIb 期，n=24）和 37.5%（IIIc 期，n=8）（p<0.001）。
结论
本研究中 LAG 治疗 AGC 的长期生存结果与先前报道的开放性胃切除术相当。基于本研究结果，需要进行一项精心设计的 III 期临床试验，比较 LAG 和开放性胃切除术治疗 AGC，以证实 LAG 治疗 AGC 的有效性。
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