Wang Yan-Na, Shen Kun-Tang, Ling Jia-Qian, Gao Xiao-Dong, Hou Ying-Yong, Wang Xue-Fei, Qin Jing, Sun Yi-Hong, Qin Xin-Yu
Department of General Surgery, Zhongshan Hospital of Fudan University, No 180 Fenglin Road, Shanghai, 200032, China.
BMC Surg. 2012 Oct 12;12:20. doi: 10.1186/1471-2482-12-20.
Gastric cancer with synchronous liver metastasis remains a clinical treatment challenge. There has been a longstanding debate on the question whether surgical resection could be beneficial to long-term survival. This study is to investigate the effectiveness and prognostic factors of combined curative resection of the stomach and liver lesions in gastric cancer patients with synchronous liver metastases.
A total of 30 patients who underwent simultaneous curative gastric and liver resection from March 2003 to April 2008 were analyzed retrospectively. Univariate and multivariate analyses were performed to select independent factors for survival.
The overall 1-, 2-, 3- and 5-year survival rates of 30 patients were 43.3%, 30.0%, 16.7% and 16.7%, respectively, with a median survival of 11.0 months and 5 patients still living by the time of last follow-up. Single liver metastasis (p=0.028) and an absence of peritoneal dissemination (p=0.007) were significantly independent prognostic factors for these gastric cancer patients with synchronous liver metastases. Major adverse events were protracted stomach paralysis in 2 patients and pulmonary infection in another 2 patients, all of whom recovered after conservative treatment.
This descriptive study without control group found that patients with solitary liver metastasis and absence of peritoneal dissemination could have better survival benefit from simultaneous curative resection of the gastric cancer and liver metastases.
伴有同时性肝转移的胃癌仍然是临床治疗的一大挑战。对于手术切除是否有利于长期生存这一问题，长期以来一直存在争议。本研究旨在探讨同时性肝转移的胃癌患者行胃和肝病灶联合根治性切除的有效性及预后因素。
回顾性分析2003年3月至2008年4月期间共30例行同期胃癌和肝根治性切除的患者。进行单因素和多因素分析以选择生存的独立因素。
30例患者的1年、2年、3年和5年总生存率分别为43.3%、30.0%、16.7%和16.7%，中位生存期为11.0个月，至末次随访时有5例患者仍存活。单发性肝转移（p = 0.028）和无腹膜播散（p = 0.007）是这些同时性肝转移胃癌患者显著的独立预后因素。主要不良事件为2例患者出现持续性胃麻痹，另2例患者出现肺部感染，所有患者经保守治疗后均康复。
这项无对照组的描述性研究发现，孤立性肝转移且无腹膜播散的患者同时行胃癌和肝转移灶根治性切除可能有更好的生存获益。
