Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
J Gastrointest Surg. 2019 Sep;23(9):1758-1766. doi: 10.1007/s11605-018-3983-7. Epub 2018 Sep 27.
Patients with positive peritoneal cytology (CY1) or peritoneal dissemination (P1) have significantly poor prognosis. We performed pre-therapeutic staging laparoscopy (SL) to diagnose peritoneal metastasis for patients with advanced gastric cancer. When peritoneal metastasis disappears by chemotherapy for patients with CY1 or P1, we have intention to perform conversion surgery (CS). This study aims to clarify the clinical significance of CS for such patients.
We retrospectively analyzed clinical outcomes of 115 patients with advanced gastric cancer (large type 3, type 4, serosa-invasion) who underwent SL between 2005 and 2014. Disappearance of peritoneal metastasis was confirmed by second-look SL.
CY0P0, CY1P0, and P1 were found in 56, 26, and 33 patients, respectively. In patients with CY1P0, 12 patients (66.7%) underwent CS (R0) as peritoneal cytology turned negative. All cases received S-1-based regimens, with median five treatment courses. The survival of patients with CS was significantly longer than those without CS (median survival time (MST); 41 vs. 11 months, respectively, P < 0.001). We observed no difference in overall survival between patients who underwent CS and patients with CY0P0 at the first SL (P = 0.913). All patients with P1 received chemotherapy. As peritoneal metastasis of five patients (15.2%) disappeared by chemotherapy, those patients underwent the CS (R0). The survival of patients who underwent CS was significantly longer than those who did not (MST; 31 vs. 10 months, respectively, P = 0.034).
This study suggests that conversion surgery contributes to improvement in survival of patients with peritoneal metastasis.
阳性腹膜细胞学（CY1）或腹膜播散（P1）的患者预后显著较差。我们对进展期胃癌患者进行术前诊断性腹腔镜检查（SL）以诊断腹膜转移。对于 CY1 或 P1 的患者，当化疗使腹膜转移消失时，我们有意进行转化手术（CS）。本研究旨在阐明 CS 对这些患者的临床意义。
我们回顾性分析了 2005 年至 2014 年间接受 SL 的 115 例进展期胃癌（大型 3 型、4 型、浆膜侵犯）患者的临床结果。通过二次 SL 确认腹膜转移消失。
CY0P0、CY1P0 和 P1 在 56、26 和 33 例患者中分别发现。CY1P0 患者中有 12 例（66.7%）接受了 CS（R0），因为腹膜细胞学转为阴性。所有病例均接受了 S-1 为基础的方案治疗，中位治疗疗程为 5 个。接受 CS 的患者的生存时间明显长于未接受 CS 的患者（中位生存时间（MST）；分别为 41 个月和 11 个月，P<0.001）。我们观察到首次 SL 时接受 CS 的患者与 CY0P0 患者的总生存率无差异（P=0.913）。所有 P1 患者均接受化疗。由于五名患者（15.2%）的腹膜转移通过化疗消失，这些患者接受了 CS（R0）。接受 CS 的患者的生存时间明显长于未接受 CS 的患者（MST；分别为 31 个月和 10 个月，P=0.034）。
本研究表明转化手术有助于改善腹膜转移患者的生存。
