Haugstvedt T, Viste A, Eide G E, Söreide O
World J Surg. 1989 Sep-Oct;13(5):617-21; discussion 621-2. doi: 10.1007/BF01658884.
Five hundred three of 1,165 patients with stomach cancer included in a national multicenter study received noncurative treatment. This study elucidates whether a palliative resection offered any survival advantage compared to nonresectional treatment. One hundred eighty-two (36%) of 503 patients had gastric resection (including total gastrectomy in 64 patients), 70 (14%) had a bypass procedure, and an exploratory laparotomy was carried out in 156 (31%). Seventy-eight patients (16%) were not subjected to surgery. Resection carried the same postoperative mortality rate as a nonresectional procedure (13% versus 12%). Univariate survival analysis demonstrated that median survival and 1- and 2-year survival rates were significantly higher in resected patients; however, as basic patient characteristics (age, stage, etc.) differed between the 2 main treatment groups, survival and factors affecting survival were analyzed using the Cox proportional hazards model. Given similar age and preoperative weight loss, resection doubled median survival both for stage III disease (9 versus 4.5 mo) and for stage IV disease (6 versus 3 mo) compared to nonresection or no operation. In conclusion, resection seems justified in patients with advanced stomach cancer since a survival benefit is documented.
一项全国多中心研究纳入的1165例胃癌患者中，503例接受了非根治性治疗。本研究阐明了姑息性切除与非切除治疗相比是否具有生存优势。503例患者中有182例（36%）接受了胃切除术（包括64例行全胃切除术），70例（14%）接受了旁路手术，156例（31%）进行了剖腹探查术。78例患者（16%）未接受手术。切除术后的死亡率与非切除手术相同（分别为13%和12%）。单因素生存分析表明，切除术后患者的中位生存期、1年和2年生存率显著更高；然而，由于两个主要治疗组的基本患者特征（年龄、分期等）不同，使用Cox比例风险模型分析了生存情况及影响生存的因素。在年龄和术前体重减轻情况相似的前提下，与未切除或未手术相比，对于Ⅲ期疾病，切除术后的中位生存期翻倍（9个月对4.5个月），对于Ⅳ期疾病，切除术后的中位生存期也翻倍（6个月对3个月）。总之，鉴于已证明切除术后有生存获益，对于晚期胃癌患者，切除手术似乎是合理的。
