腹腔镜下胃癌 D2 根治术治疗进展期胃癌。
Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer.
机构信息
Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.
出版信息
World J Surg. 2012 Oct;36(10):2394-9. doi: 10.1007/s00268-012-1669-y.
BACKGROUND
The use of laparoscopic total gastrectomy (LTG) for the treatment of advanced gastric cancer (AGC) has not yet gained widespread acceptance because of difficulties in performing D2 lymphadenectomy. The purpose of this study was to evaluate the safety and effectiveness of LTG with D2 lymphadenectomy in treating AGC.
METHODS
A total of 94 patients who underwent LTG with D2 lymphadenectomy for AGC between January 2005 and October 2011 were included in this study. The patient data were obtained from a prospectively maintained institutional database. Morbidity was stratified by the Clavien-Dindo classification.
RESULTS
Concurrent pancreatectomy or splenectomy was performed on 48 patients. The median operation time was 230 min, and the median number of lymph nodes harvested per patient was 60.5. The TNM stages of the tumor were Ib in 9 patients (9.6 %), IIa in 16 (17 %), IIb in 7 (7.4 %), IIIa in 16 (17 %), IIIb in 17 (18.1 %), IIIc in 25 (26.6 %), and IV in 4 (4.3 %). Major morbidity (≥ grade IIIa) occurred in 9 patients (9.6 %) without postoperative mortality. At last follow-up, tumor recurrence had occurred in 13 patients with a median follow-up time of 12.77 months.
CONCLUSIONS
The acceptable rate of major morbidity in our series suggested that laparoscopic total gastrectomy with D2 lymphadenectomy is applicable to AGC. Long-term follow-up is mandatory to validate long-term outcome.
背景
由于在施行 D2 淋巴结清扫术方面存在困难，腹腔镜全胃切除术（LTG）治疗进展期胃癌（AGC）尚未得到广泛认可。本研究旨在评估 LTG 联合 D2 淋巴结清扫术治疗 AGC 的安全性和有效性。
方法
本研究纳入了 2005 年 1 月至 2011 年 10 月期间接受 LTG 联合 D2 淋巴结清扫术治疗 AGC 的 94 例患者。患者数据来自一个前瞻性维护的机构数据库。发病率按 Clavien-Dindo 分类分层。
结果
48 例患者同时行胰体尾切除术或脾切除术。中位手术时间为 230 分钟，每位患者平均淋巴结清扫数目为 60.5 个。肿瘤的 TNM 分期为 Ib 期 9 例（9.6%），IIa 期 16 例（17%），IIb 期 7 例（7.4%），IIIa 期 16 例（17%），IIIb 期 17 例（18.1%），IIIc 期 25 例（26.6%），IV 期 4 例（4.3%）。9 例（9.6%）患者发生主要并发症（≥3a 级），无术后死亡。末次随访时，13 例患者出现肿瘤复发，中位随访时间为 12.77 个月。
结论
本研究中主要并发症的可接受率表明，腹腔镜全胃切除术联合 D2 淋巴结清扫术适用于 AGC。需要长期随访以验证长期疗效。
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