Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland.
J Surg Oncol. 2012 Aug 1;106(2):193-6. doi: 10.1002/jso.23066. Epub 2012 Feb 21.
The role of non-curative or palliative gastrectomy remains controversial. Our aim was to compare retrospective patients who have undergone non-curative gastrectomy to the patients with surgical exploration only.
Between years 2000 and 2009, 488 patients with gastric adenocarcinoma were treated at the Department of Surgery, Helsinki University Central Hospital. Fifty-five patients had metastatic disease but their symptoms were not severe enough to require palliative surgery. Thirty-two of them underwent operative exploration (Group A), and 23 non-curative gastrectomy (Group B). All operations were initiated with curative intent.
The difference in median survival between Groups A and B was insignificant (5.7 months in Group A and 10.8 months in Group B, P = 0.152). However, 33 patients with postoperative chemotherapy had significantly better median survival than the others (14.2 months vs. 1.9 months, P < 0.001). No significant differences were observed between Groups A and B in the rate of late postoperative gastrointestinal obstruction or bleeding.
Non-curative gastrectomy does not improve survival in patients with metastatic gastric cancer, nor reduces the rate of late occlusions. There is no need for prophylactic palliative gastrectomy in patients with gastric cancer who do not have bleeding or obstruction preoperatively. Among those patients, postoperative chemotherapy seems to improve survival.
非治愈性或姑息性胃切除术的作用仍存在争议。我们的目的是将接受非治愈性胃切除术的回顾性患者与仅接受手术探查的患者进行比较。
在 2000 年至 2009 年间，赫尔辛基大学中心医院外科治疗了 488 例胃腺癌患者。55 例患者患有转移性疾病，但症状严重程度不足以进行姑息性手术。其中 32 例患者接受了手术探查（A 组），23 例患者接受了非治愈性胃切除术（B 组）。所有手术均以治愈为目的开始。
A 组和 B 组之间的中位生存期差异无统计学意义（A 组为 5.7 个月，B 组为 10.8 个月，P=0.152）。然而，33 例接受术后化疗的患者中位生存期明显优于其他患者（14.2 个月比 1.9 个月，P<0.001）。A 组和 B 组之间在术后晚期胃肠道梗阻或出血的发生率方面没有显著差异。
非治愈性胃切除术不能改善转移性胃癌患者的生存，也不能降低晚期梗阻的发生率。对于术前无出血或梗阻的胃癌患者，无需预防性进行姑息性胃切除术。在这些患者中，术后化疗似乎可以提高生存率。
