Mizuno Akira, Kanda Mitsuro, Kobayashi Daisuke, Tanaka Chie, Iwata Naoki, Yamada Suguru, Fujii Tsutomu, Nakayama Goro, Sugimoto Hiroyuki, Koike Masahiko, Fujiwara Michitaka, Kodera Yasuhiro
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
Dig Surg. 2016;33(2):121-8. doi: 10.1159/000443219. Epub 2016 Jan 9.
BACKGROUND/AIMS: Gastrectomy with systemic lymphadenectomy sometimes causes excessive bleeding even by experienced surgeons. The aim of this study was to evaluate how intraoperative estimated blood loss (EBL) affected the long-term outcomes after curative surgery of patients with stage II/III gastric cancer (GC).
This study included 203 patients with stage II/III GC who did not receive perioperative blood transfusion between 1999 and 2015. The optimal cutoff and the prognostic significance of EBL were determined retrospectively.
The median EBL was 285 ml. Receiver operating characteristic curve analysis identified 400 ml as an optimal cutoff. Patients with EBL ≥400 ml were more likely to have hepatic relapse and worse prognosis compared to those with EBL <400 ml. EBL ≥400 ml was identified as an independent prognostic factor for mortality by multivariable analysis. When patients were subdivided according to administration of adjuvant chemotherapy, there was a significant difference between the EBL ≥400 and <400 ml groups in patients who underwent surgery alone, whereas the prognosis was similar for patients of both groups who received adjuvant chemotherapy.
EBL serves as a useful predictor for risk stratification after curative gastrectomy in patients with stage II/III GC.
背景/目的：即使是经验丰富的外科医生，进行胃切除术并系统性淋巴结清扫时有时也会导致大量出血。本研究的目的是评估术中估计失血量（EBL）如何影响II/III期胃癌（GC）患者根治性手术后的长期预后。
本研究纳入了1999年至2015年间未接受围手术期输血的203例II/III期GC患者。回顾性确定EBL的最佳截断值及其预后意义。
EBL中位数为285ml。受试者工作特征曲线分析确定400ml为最佳截断值。与EBL<400ml的患者相比，EBL≥400ml的患者更易发生肝转移且预后更差。多变量分析确定EBL≥400ml是死亡的独立预后因素。根据辅助化疗的使用情况对患者进行细分时，单纯接受手术的患者中，EBL≥400ml组和<400ml组之间存在显著差异，而接受辅助化疗的两组患者预后相似。
EBL可作为II/III期GC患者根治性胃切除术后风险分层的有用预测指标。
