腹腔镜保留脾脏的脾门淋巴结清扫术对近端胃癌手术结局的影响：一项倾向评分匹配的病例对照研究。
The effects of laparoscopic spleen-preserving splenic hilar lymphadenectomy on the surgical outcome of proximal gastric cancer: a propensity score-matched, case-control study.
作者信息
Huang Chang-Ming, Chen Tan, Lin Jian-Xian, Chen Qi-Yue, Zheng Chao-Hui, Li Ping, Xie Jian-Wei, Wang Jia-Bin, Lu Jun, Cao Long-Long, Lin Mi, Tu Ru-Hong
机构信息
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
出版信息
Surg Endosc. 2017 Mar;31(3):1383-1392. doi: 10.1007/s00464-016-5126-0. Epub 2016 Jul 22.
BACKGROUND
The evidence regarding the long-term results of laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) has only been rarely reported. The aim of this study was to investigate the feasibility and oncologic efficacy of LSPL for locally advanced proximal gastric cancer.
METHODS
From May 2007 to December 2012, we prospectively collected and retrospectively analyzed the data of 548 patients who underwent laparoscopic radical total gastrectomy due to proximal gastric cancer. The patients were grouped according to spleen-preserving splenic hilar lymphadenectomy (200 in the D2 group and 348 in the D2-group). The short- and long-term outcomes were compared between the two groups after propensity score matching.
RESULTS
Before matching, TNM stages were significantly different between the D2 and D2-groups. After propensity score matching, the two groups were well balanced in clinicopathologic characteristics. After matching, the time for lymph node dissection was longer in the D2 group, but a greater number of lymph nodes were dissected; the estimated blood loss, time to first flatus and duration of hospital stay were similar in the two groups. Furthermore, no significant differences in morbidity and mortality were found. Before matching, the 3-year overall survival (OS) and disease-free survival (DFS) rates of the D2 group were comparable with those of the D2-group (62.4 vs. 57.7 %, p = 0.076). After matching, the 3-year OS remained comparable, but the D2 group showed significantly longer 3-year DFS (61.6 vs. 53.7 %, p = 0.034). Stratified analysis showed that, in stage III patients, the D2 group had better 3-year DFS. Multivariate Cox regression showed that age (p = 0.003), operation (p = 0.001) and pN stage (p < 0.001) were independent prognostic factors.
CONCLUSIONS
LSPL is a safe and feasible procedure, and patients with stage III proximal gastric cancer might obtain higher 3-year DFS rates.
背景
关于腹腔镜保留脾脏的脾门淋巴结清扫术（LSPL）长期结果的证据鲜有报道。本研究旨在探讨LSPL用于局部进展期近端胃癌的可行性及肿瘤学疗效。
方法
2007年5月至2012年12月，我们前瞻性收集并回顾性分析了548例因近端胃癌接受腹腔镜根治性全胃切除术患者的数据。患者根据是否行保留脾脏的脾门淋巴结清扫术分组（D2组200例，未行该术式组348例）。倾向评分匹配后比较两组的短期和长期结局。
结果
匹配前，D2组与未行该术式组的TNM分期存在显著差异。倾向评分匹配后，两组的临床病理特征均衡良好。匹配后，D2组淋巴结清扫时间更长，但清扫的淋巴结数量更多；两组的估计失血量、首次排气时间及住院时间相似。此外，两组在发病率和死亡率方面未发现显著差异。匹配前，D2组的3年总生存率（OS）和无病生存率（DFS）与未行该术式组相当（62.4%对57.7%，p = 0.076）。匹配后，3年OS仍相当，但D2组的3年DFS显著更长（61.6%对53.7%，p = 0.034）。分层分析显示，在Ⅲ期患者中，D2组的3年DFS更好。多因素Cox回归显示，年龄（p = 0.003）、手术方式（p = 0.001）和pN分期（p < 0.001）是独立的预后因素。
结论
LSPL是一种安全可行的手术方式，Ⅲ期近端胃癌患者可能获得更高的3年DFS率。
Zotero 插件