D2 胃切除术联合 versus 不联合胆囊切除术治疗胃癌。

D2 gastrectomy with versus without bursectomy for gastric cancer.

机构信息

Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.

出版信息

Am J Clin Oncol. 2014 Jun;37(3):222-6. doi: 10.1097/COC.0b013e31825eb734.

DOI:10.1097/COC.0b013e31825eb734

PMID:22892432

Abstract

OBJECTIVES

The purpose of this study was to determine the survival benefit of bursectomy by retrospectively comparing the prognosis in patients undergoing D2 lymphadenectomy and gastrectomy (D2 gastrectomy) with bursectomy for gastric cancer with that in patients undergoing D2 gastrectomy alone.

METHODS

A total of 254 consecutive stage IA to IIIC gastric cancer patients undergoing curative intent surgery between 2004 and 2009 were enrolled. The patients were divided into 2 groups: a bursectomy group, which included patients undergoing curative D2 gastrectomy with bursectomy by one surgeon, and a nonbursectomy group, which included those undergoing curative D2 gastrectomy alone by other surgeons.

RESULTS

No statistically significant difference was observed in the number of metastatic nodes or penetration of the serosa between the 2 groups. The overall incidence of surgery-related complications was 24.0% in the bursectomy group (29 of 121 patients) and 25.6% in the nonbursectomy group (34 of 133 patients). The 5-year overall survival rate was 85.8% in the bursectomy group and 80.8% in the nonbursectomy group (hazard ratio 0.82; 95% confidence interval, 0.37-1.74; P=0.60).

CONCLUSIONS

The results of this retrospective study indicate no survival benefit for bursectomy plus D2 gastrectomy over D2 gastrectomy alone.

摘要

目的

本研究旨在通过回顾性比较接受 D2 淋巴结清扫和胃切除术（D2 胃切除术）加脾切除术与单独接受 D2 胃切除术治疗胃癌患者的预后，确定脾切除术的生存获益。

方法

共纳入 2004 年至 2009 年间接受根治性手术的 254 例连续分期 IA 至 IIIC 期胃癌患者。患者分为 2 组：脾切除术组，包括由一位外科医生进行的根治性 D2 胃切除术加脾切除术的患者；非脾切除术组，包括由其他外科医生进行的根治性 D2 胃切除术的患者。

结果

两组间转移淋巴结的数量或浆膜穿透无统计学差异。脾切除术组手术相关并发症的总发生率为 24.0%（121 例患者中的 29 例），非脾切除术组为 25.6%（133 例患者中的 34 例）。脾切除术组和非脾切除术组的 5 年总生存率分别为 85.8%和 80.8%（风险比 0.82；95%置信区间，0.37-1.74；P=0.60）。