单中心 528 例腹腔镜胃癌根治术的临床经验。

Clinical experience of 528 laparoscopic gastrectomies on gastric cancer in a single institution.

机构信息

Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.

出版信息

Surgery. 2013 May;153(5):611-8. doi: 10.1016/j.surg.2012.10.019. Epub 2013 Jan 4.

DOI:10.1016/j.surg.2012.10.019

PMID:23294878

Abstract

BACKGROUND

Laparoscopic gastrectomy (LG) for locally advanced gastric cancer (AGC) as well as early gastric cancer (EGC) has gradually gained popularity. However, long-term experiences of LG for AGC as well as EGC rarely have been reported.

METHODS

A total of 528 patients with gastric cancer were enrolled in the study, and clinical experiences of LG were evaluated.

RESULTS

The study included 332 men and 196 women. The mean age was 61.3 ± 11.8 years. Of the 528 patients, 432 underwent distal gastrectomy, 87 had a total gastrectomy, and 9 had a proximal gastrectomy. There were 198 T1a, 139 T1b, 63 T2, 83 T3, and 45 T4a lesions. In 127 patients, lymph node metastasis was observed, and the rate of it was 1.5% in T1a, 12.2% in T1b, 34.9% in T2, 59.0% in T3, and 80.0% in T4a. The median follow-up period was 24 months (range, 1-83 months). The 5-year survival and disease-free survival rates according to the stage of tumor were 99.3% and 97.8% in stage I, 95.4% and 89.7% in stage II, and 44.4% and 31.3% in stage III, respectively. Operation related morbidities occurred in 45 patients, and there were 2 mortalities. Tumors recurred in 36 patients consisting of 2 in T1a, 2 T1b, 2 T2, 12 T3, and 18 T4a. Carcinomatosis peritonei was observed most commonly.

CONCLUSION

In our experience, oncologic results and the safety of LG for EGC and serosa-negative AGC were acceptable. This treatment may be considered as an alternative operative approach.

摘要

背景

腹腔镜胃切除术（LG）在局部进展期胃癌（AGC）和早期胃癌（EGC）中的应用逐渐普及。然而，对于 AGC 和 EGC 患者行 LG 的长期经验却很少有报道。

方法

本研究共纳入 528 例胃癌患者，评估 LG 的临床经验。

结果

研究共纳入 332 例男性和 196 例女性患者，平均年龄为 61.3±11.8 岁。528 例患者中，432 例行远端胃切除术，87 例行全胃切除术，9 例行近端胃切除术。198 例为 T1a 期，139 例为 T1b 期，63 例为 T2 期，83 例为 T3 期，45 例为 T4a 期。127 例患者存在淋巴结转移，T1a 期淋巴结转移率为 1.5%，T1b 期为 12.2%，T2 期为 34.9%，T3 期为 59.0%，T4a 期为 80.0%。中位随访时间为 24 个月（1-83 个月）。根据肿瘤分期，Ⅰ期患者的 5 年生存率和无病生存率分别为 99.3%和 97.8%，Ⅱ期为 95.4%和 89.7%，Ⅲ期为 44.4%和 31.3%。45 例患者发生与手术相关的并发症，2 例死亡。36 例患者肿瘤复发，其中 2 例为 T1a 期，2 例为 T1b 期，2 例为 T2 期，12 例为 T3 期，18 例为 T4a 期。最常见的是腹膜转移。