Nakagawa M, Kojima K, Inokuchi M, Kato K, Sugita H, Kawano T, Sugihara K
Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan.
Center for Minimally Invasive Surgery, Tokyo Medical Dental University, Japan.
Eur J Surg Oncol. 2014 Oct;40(10):1376-82. doi: 10.1016/j.ejso.2014.04.015. Epub 2014 May 22.
To clarify the patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy.
From January 1999 to March 2012, 577 patients underwent laparoscopic or laparoscopy-assisted gastrectomy for curative resection of gastric cancer. Recurrence patterns were classified as locoregional, hematogenous, peritoneal, distant lymph node and mixed. Recurrence patterns and time to recurrence were retrospectively examined and risk factors for recurrence were analyzed.
Recurrence occurred in 28 (4.9%) cases with patterns as follows: locoregional in 2 patients (7.1%), hematogenous in seven (25.0%), peritoneal in nine (32.1%), distant lymph node in four (14.3%), and mixed in 6 (21.4%). There was no recurrence pattern peculiar to laparoscopic surgery. Recurrence occurred at one site in 21 patients (78.6%), two in 4 patients (14.3%), and three in 2 patients (7.1%). The median time to recurrence was 384 days (range 83-1497 days). Recurrence was detected within a year in 13 cases (46.4%), within two years in 21 (75%), and within three years in 25 (89.3%). Univariate analysis revealed tumor location, tumor size, type of operation, tumor depth, and lymph node classification as risk factors for recurrence. Multivariate analysis indicated tumor depth and lymph node classification as risk factors of recurrence.
Patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy are similar to those after open gastrectomy, with no peculiarities specific to laparoscopic gastrectomy. Thus, as long as laparoscopic gastrectomy is performed according to the present inclusion criteria, follow-up can be similarly performed as for open gastrectomy.
明确腹腔镜胃切除术后胃癌复发的模式、时间及危险因素。
1999年1月至2012年3月，577例患者接受了腹腔镜或腹腔镜辅助胃癌根治性切除术。复发模式分为局部区域复发、血行转移、腹膜种植、远处淋巴结转移及混合性复发。对复发模式及复发时间进行回顾性分析，并分析复发的危险因素。
28例（4.9%）出现复发，其模式如下：局部区域复发2例（7.1%），血行转移7例（25.0%），腹膜种植9例（32.1%），远处淋巴结转移4例（14.3%），混合性复发6例（21.4%）。没有腹腔镜手术特有的复发模式。21例患者（78.6%）在一个部位复发，4例（14.3%）在两个部位复发，2例（7.1%）在三个部位复发。复发的中位时间为384天（范围83 - 1497天）。13例（46.4%）在1年内检测到复发，21例（75%）在2年内，25例（89.3%）在3年内。单因素分析显示肿瘤位置、肿瘤大小、手术方式、肿瘤深度及淋巴结分类为复发的危险因素。多因素分析表明肿瘤深度和淋巴结分类是复发的危险因素。
腹腔镜胃切除术后胃癌复发的模式、时间及危险因素与开腹胃切除术后相似，没有腹腔镜胃切除术特有的情况。因此，只要按照目前的纳入标准进行腹腔镜胃切除术，随访可与开腹胃切除术类似进行。
