Masuzawa Toru, Takiguchi Shuji, Hirao Motohiro, Imamura Hiroshi, Kimura Yutaka, Fujita Junya, Miyashiro Isao, Tamura Shigeyuki, Hiratsuka Masahiro, Kobayashi Kenji, Fujiwara Yoshiyuki, Mori Masaki, Doki Yuichiro
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
World J Surg. 2014 May;38(5):1100-6. doi: 10.1007/s00268-013-2370-5.
Various surgical procedures are used to treat early gastric cancers in the upper third of the stomach (U-EGCs). However, there is no general agreement regarding the optimal surgical procedure.
The medical records of 203 patients with U-EGC were collected from 13 institutions. Surgical procedures were classified as Roux-en-Y esophagojejunostomy after total gastrectomy (TG-RY), esophagogastrostomy after proximal gastrectomy (PG-EG), or jejunal interposition after PG (PG-JI). Patient clinical characteristics and perioperative and long-term outcomes were compared among these three groups.
TG-RY, PG-EG, and PG-JI were performed in 122, 49, and 32 patients, respectively. Tumors were larger in TG-RY patients than in PG-EG and PG-JI patients, and undifferentiated-type gastric adenocarcinoma tended to be more frequent in TG-RY than in PG-EG. The operative time was shorter for PG-EG than for PG-JI and TG-RY. Hospital stay and early postoperative complications were not different for the three procedures. With respect to gastrectomy-associated symptoms, a "stuck feeling" and heartburn tended to be more frequent in PG-EG patients, while dumping syndrome and diarrhea were more frequent in TG-RY patients. Post-surgical weight loss was not different among the three groups, however, serum albumin and hemoglobin levels tended to be lower in TG-RY patients.
Three surgical procedures for U-EGC did not result in differences in weight loss, but PG-EG and PG-JI were better than TG-RY according to some nutritional markers. In U-EGC, where patients are expected to have long survival times, PG-EG and PG-JI should be used rather than TG-RY.
多种手术方式用于治疗胃上部早期胃癌（U-EGC）。然而，关于最佳手术方式尚无普遍共识。
收集了13家机构203例U-EGC患者的病历。手术方式分为全胃切除术后Roux-en-Y食管空肠吻合术（TG-RY）、近端胃切除术后食管胃吻合术（PG-EG）或近端胃切除术后空肠间置术（PG-JI）。比较这三组患者的临床特征、围手术期和长期结局。
分别有122例、49例和32例患者接受了TG-RY、PG-EG和PG-JI手术。TG-RY组患者的肿瘤比PG-EG组和PG-JI组患者的肿瘤大，TG-RY组未分化型胃腺癌的发生率往往高于PG-EG组。PG-EG组的手术时间比PG-JI组和TG-RY组短。三组手术的住院时间和术后早期并发症无差异。关于胃切除相关症状，PG-EG组患者“哽咽感”和烧心的发生率往往更高，而TG-RY组患者倾倒综合征和腹泻的发生率更高。三组术后体重减轻无差异，然而，TG-RY组患者的血清白蛋白和血红蛋白水平往往较低。
三种U-EGC手术方式在体重减轻方面无差异，但根据一些营养指标，PG-EG和PG-JI优于TG-RY。在预期患者生存期较长的U-EGC中，应采用PG-EG和PG-JI而非TG-RY。
