Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Br J Surg. 2018 Oct;105(11):1471-1479. doi: 10.1002/bjs.10881. Epub 2018 Jul 2.
Surgery for gastric cancer may result in free intraperitoneal cancer cells. This study aimed to determine whether laparoscopic gastrectomy with complete mesogastric excision (D2 + CME) reduces the number of free intraperitoneal cancer cells.
Patients with gastric cancer who had a conventional D2 or D2 + CME laparoscopic distal gastrectomy between April 2015 and February 2017 were included in the study. Intraoperative peritoneal washings were collected before and after tumour resection. Reverse transcriptase-quantitative real-time PCR for carcinoembryonic antigen (CEA) was used to assess the presence of gastric cancer cells.
Eighty-five patients underwent conventional D2 lymphadenectomy and 76 had the D2 + CME procedure. Of 161 peritoneal fluid samples obtained before gastrectomy, 137 (D2, 72; D2 + CME, 65) had low CEA expression indicative of no cancer cells. After gastrectomy, high CEA expression was detected in 23 of the 72 samples (32 per cent) from patients in the D2 group, and in ten of the 65 samples (15 per cent) from the D2 + CME group. In the overall cohort, mean CEA expression level after gastrectomy was lower in the D2 + CME group than in the D2 group (P = 0·0038). In patients with low CEA expression before gastrectomy, disease-free survival in the D2 + CME group was better than that in the D2 group (P = 0·033).
Laparoscopic distal gastrectomy with complete mesogastric excision reduces the number of free intraperitoneal cancer cells and is associated with a better disease-free survival than conventional D2 gastrectomy.
胃癌手术可能导致游离腹腔癌细胞。本研究旨在确定完全横结肠系膜切除术（D2+CME）的腹腔镜胃切除术是否减少游离腹腔癌细胞的数量。
纳入 2015 年 4 月至 2017 年 2 月期间接受传统 D2 或 D2+CME 腹腔镜远端胃切除术的胃癌患者。在肿瘤切除前后采集腹腔冲洗液。采用逆转录定量实时 PCR 检测癌胚抗原（CEA）以评估胃癌细胞的存在。
85 例患者接受常规 D2 淋巴结清扫术，76 例患者接受 D2+CME 手术。在 161 份术前腹腔液样本中，137 份（D2 组 72 份；D2+CME 组 65 份）CEA 低表达，提示无癌细胞。胃切除术后，D2 组 72 份样本中有 23 份（32%）和 D2+CME 组 65 份样本中有 10 份（15%）高 CEA 表达。在总队列中，D2+CME 组术后 CEA 表达水平低于 D2 组（P=0·0038）。在术前 CEA 低表达的患者中，D2+CME 组的无病生存率优于 D2 组（P=0·033）。
与传统 D2 胃切除术相比，完全横结肠系膜切除术的腹腔镜远端胃切除术可减少游离腹腔癌细胞的数量，并与更好的无病生存率相关。
