Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2013 Oct;20(11):3512-8. doi: 10.1245/s10434-013-3024-4. Epub 2013 Jun 14.
The benefit of surgical resection in patients with incurable gastric adenocarcinoma is controversial.
A total of 289 patients who presented with advanced or metastatic gastric cancer from 1995 to 2010 were retrospectively reviewed.
Ten patients (3.5 %) required emergent surgery at presentation and were excluded from further analyses. Patients who underwent nonemergent surgery at presentation (n = 110, 38.1 %) received either gastric resection (group A, n = 46, 42 %) or surgery without resection (group B, n = 64, 58 %). Procedures in group A included distal gastrectomy (n = 25, 54 %), total gastrectomy (n = 17, 37 %), and proximal/esophagogastrectomy (n = 4, 9 %). Procedures in group B included laparoscopy (n = 17, 27 %), open exploration (n = 25, 39 %), gastrostomy and/or jejunostomy tube (n = 12, 19 %), and gastrojejunostomy (n = 10, 16 %). Group A required a stay in the intensive care unit or additional invasive procedure significantly more often than group B (15 vs. 2 %, p = 0.009). Four patients in group A (8.7 %) and three patients in group B (4.7 %) died within 30 days of surgery (p = 0.45). When the 110 patients who underwent nonemergent surgery (groups A and B) were compared to nonoperatively managed patients (group C, n = 169, 58 %), median overall survival did not significantly differ (8.6 vs. 9.2 vs. 7.7 months; p > 0.05). Three patients in group B (4.7 %) and three in group C (1.8 %) ultimately required an operation for their primary tumor.
Patients with gastric adenocarcinoma who present with advanced or metastatic disease not amenable to curative resection infrequently require emergent surgery. Noncurative resection is associated with significant perioperative morbidity and mortality as well as limited overall survival, and should therefore be performed judiciously.
手术切除对不可治愈的胃腺癌患者的益处存在争议。
回顾性分析了 1995 年至 2010 年期间就诊的 289 例晚期或转移性胃癌患者。
10 名患者（3.5%）在就诊时需要紧急手术，因此被排除在进一步分析之外。在就诊时接受非紧急手术的患者（n=110，38.1%）中，有 46 名（42%）接受了胃切除术（A 组），64 名（58%）接受了非切除术（B 组）。A 组的手术包括远端胃切除术（n=25，54%）、全胃切除术（n=17，37%）和近端/食管胃切除术（n=4，9%）。B 组的手术包括腹腔镜检查（n=17，27%）、剖腹探查（n=25，39%）、胃造口术和/或空肠造口术（n=12，19%）和胃空肠吻合术（n=10，16%）。A 组需要入住重症监护病房或接受其他侵入性治疗的比例显著高于 B 组（15% vs. 2%，p=0.009）。A 组中有 4 名患者（8.7%）和 B 组中有 3 名患者（4.7%）在手术后 30 天内死亡（p=0.45）。与非手术治疗患者（C 组，n=169，58%）相比，接受非紧急手术（A 组和 B 组）的 110 名患者的中位总生存期无显著差异（8.6 个月 vs. 9.2 个月 vs. 7.7 个月；p>0.05）。B 组中有 3 名患者（4.7%）和 C 组中有 3 名患者（1.8%）最终因原发肿瘤需要手术。
就诊时存在不可治愈的胃腺癌且不适合根治性切除的患者很少需要紧急手术。非根治性切除术与显著的围手术期发病率和死亡率以及有限的总生存期相关，因此应谨慎进行。
