Kaibara N, Koga S
First Department of Surgery, Tottori University School of Medicine, Yonago, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1418-21.
Forty percent of patients with gastric cancer with direct infiltration to adjacent organs survived for more than 5 years after curative resection. Favorable results were obtained in cases in which combined resection of the body of the pancreas or the liver was performed due to cancer infiltration. However, patients who had undergone gastrectomy with combined colectomy or pancreatoduodenectomy showed a poor survival rate. The postoperative 5-year survival rate was 29% for patients who had presented with group 3 lymph node metastasis and undergone potentially curative surgery. Particularly, favorable results were obtained in cases with metastases confined to lymph nodes in the hepatoduodenal ligament. In dissection of the deepest nodes, lymph nodes in the hepatoduodenal ligament is the most important to remove in surgery for stage IV gastric cancer. We have performed gastrectomy combined with dissection of group 1 and 2 lymph nodes in the treatment of patients with gastric cancer with peritoneal metastasis. Results obtained so far revealed that only patients with a lesser extent of serosal invasion survived longer after operation. We are presently conducting a trial of hyperthermia combined with anticancer chemotherapy as a possible method for prolongation of survival of patients with peritoneal metastasis of gastric cancer.
40%的直接浸润至邻近器官的胃癌患者在根治性切除术后存活超过5年。因癌症浸润而进行胰腺体部或肝脏联合切除的病例取得了良好的效果。然而，接受胃切除联合结肠切除或胰十二指肠切除术的患者生存率较低。出现3组淋巴结转移并接受了可能根治性手术的患者术后5年生存率为29%。特别是，转移局限于肝十二指肠韧带淋巴结的病例取得了良好的效果。在清扫最深层淋巴结时，肝十二指肠韧带淋巴结是IV期胃癌手术中最重要的切除对象。我们在治疗有腹膜转移的胃癌患者时进行了胃切除联合第1组和第2组淋巴结清扫。目前得到的结果显示，只有浆膜侵犯程度较轻的患者术后存活时间更长。我们目前正在进行一项热疗联合抗癌化疗的试验，作为延长胃癌腹膜转移患者生存期的一种可能方法。
