Department of Gastroenterological Surgery, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
World J Surg. 2012 Oct;36(10):2412-9. doi: 10.1007/s00268-012-1681-2.
The purpose of this study was to clarify the surgical indications for gastrectomy combined with distal or partial pancreatectomy (GP) in patients with gastric cancer.
From January 1994 to December 2009, 29 patients with primary gastric cancer surgically invading the pancreas without distant organ metastasis underwent GP for R0 resection. The patients' characteristics, surgical data, and clinicopathological features were used for the analysis of survival and prognostic factors.
The median disease-free survival and median survival time (MST) of all patients were 15 and 30 months, respectively. Only pN3 status (characterized by 7 or more pathologically metastatic lymph nodes) according to the Japanese Classification of Gastric Carcinoma, 14th edition, was shown to be a prognostic factor in a multivariate analysis. The MST of the patients with pN3 and the other patients were 12 and 51 months, respectively (p < 0.001).
We suggest that pancreas invasion should not be considered a contraindication for gastrectomy and that patients with a small number of lymph node metastases (six or fewer) might be candidates for GP in the case of gastric cancer that requires pancreatectomy for R0 resection.
本研究旨在阐明胃癌合并远端或胰体尾切除术（GP）的手术适应证。
自 1994 年 1 月至 2009 年 12 月，29 例原发性胃癌侵犯胰腺但无远处器官转移的患者接受 GP 行 R0 切除术。分析了患者的特征、手术数据和临床病理特征，以评估生存和预后因素。
所有患者的无病生存期和中位总生存期（MST）中位数分别为 15 个月和 30 个月。仅日本胃癌分类第 14 版中的 pN3 状态（特征为 7 个或更多病理转移淋巴结）在多因素分析中显示为预后因素。pN3 患者和其他患者的 MST 分别为 12 个月和 51 个月（p<0.001）。
我们认为胰腺侵犯不应作为胃切除术的禁忌证，对于需要行胰体尾切除术以达到 R0 切除的胃癌患者，淋巴结转移数较少（6 个或更少）的患者可能是 GP 的候选者。
