Anfossi A, Gori A, Secco G B, Percivale P L
Divisione di Chirurgia Generale, Regione Liguria, USL n. 4, Ospedale di Albenga.
Minerva Chir. 1990 Sep 15;45(17):1077-82.
Five hundred and fifty patients operated between 1965 and 1983 for stomach carcinoma were included in the study. Of these, 244 (44.4%) underwent extended (54 patients) or palliative surgery (190 patients) due to the extragastric diffusion of the neoplasia. Global postoperative mortality for patients undergoing extended surgery was 16.7% and the five-year survival rate was 18.5%; in the case of those undergoing palliative surgery the postoperative mortality rate was 30.5% and the two-year survival rate was 14% for resection and 4% for derivatives. Patients who underwent a derivative operation showed an easing of symptoms and an improved quality of life. On the basis of these results the Authors consider that the possibility of extended surgery should still be carefully evaluated in patients in whom a stomach tumour has exceeded the gastric boundary, irrespective of its extent, since the limit of radical surgery is not related to the extension of surgical demolition but to the entity of the extragastric diffusion of the neoplasia. In addition, surgical abstention is not always justified even in patients in whom surgery cannot be curative since a 10% five-year survival rate was observed in patients undergoing palliative resection.
1965年至1983年间接受胃癌手术的550例患者纳入了该研究。其中，244例（44.4%）因肿瘤的胃外扩散接受了扩大手术（54例）或姑息性手术（190例）。接受扩大手术患者的总体术后死亡率为16.7%，五年生存率为18.5%；接受姑息性手术的患者，术后死亡率为30.5%，切除术后的两年生存率为14%，改道术为4%。接受改道术的患者症状有所缓解，生活质量得到改善。基于这些结果，作者认为，对于胃肿瘤已超出胃边界的患者，无论其范围如何，仍应仔细评估扩大手术的可能性，因为根治性手术的限度并非与手术切除范围相关，而是与肿瘤的胃外扩散程度有关。此外，即使在手术无法治愈的患者中，手术放弃也并非总是合理的，因为接受姑息性切除的患者观察到有10%的五年生存率。
