Lui Su-Ann, Tan Wee Boon, Tai Bee Choo, Yong Wei Peng, Mu Yar Soe, Ti Thiow Kong, Shabbir Asim, So Jimmy
Department of Surgery, National University Hospital, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
ANZ J Surg. 2019 Jan;89(1-2):84-89. doi: 10.1111/ans.15011. Epub 2019 Jan 28.
Radical surgery with adjuvant therapy is now the standard treatment for locally advanced gastric cancer. However, the best regimen for adjuvant therapy remains controversial. We aim to determine the predictors of survival outcome of gastric cancer patients who underwent curative surgery with or without adjuvant therapy in our institution.
All patients who received surgery for gastric cancer from years 2000 to 2015 were studied using a prospective gastric cancer database at the National University Hospital, Singapore.
A total of 405 patients underwent radical gastrectomy with curative intent. Seventy-eight percent received extended lymphadenectomy (≥D1). R0 resection was achieved in 377 patients (93%) with 30-day mortality rate of 1.7%. There was no significant difference in the complication rate between D1 and extended lymphadenectomy group. One hundred and forty-five patients (36%) received adjuvant therapy. With a median follow-up of 5.9 years, the 5-year disease-free survival for stage I to IV patients were 78%, 58%, 27% and 9%, respectively. Among the 141 patients with known recurrences, the first site of recurrence was 38% distant, 24% locoregional, 20% peritoneal and the rest were multiple sites. Stage of disease, adjuvant therapy, extent of lymphadenectomy, post-operative complication and approach of surgery were independent risk factors for long-term survival.
Stage of disease, adjuvant therapy, extent of lymphadenectomy, post-operative complication and approach of surgery are significant predictors for long-term survival. Adequate and safe surgery to allow adjuvant therapy should be the goal of all surgeons for our gastric cancer patients.
根治性手术联合辅助治疗目前是局部进展期胃癌的标准治疗方法。然而，辅助治疗的最佳方案仍存在争议。我们旨在确定在本院接受了根治性手术（无论是否接受辅助治疗）的胃癌患者生存结局的预测因素。
使用新加坡国立大学医院的前瞻性胃癌数据库，对2000年至2015年期间所有接受胃癌手术的患者进行研究。
共有405例患者接受了根治性胃切除术，目的是治愈。78%的患者接受了扩大淋巴结清扫术（≥D1）。377例患者（93%）实现了R0切除，30天死亡率为1.7%。D1组和扩大淋巴结清扫术组之间的并发症发生率无显著差异。145例患者（36%）接受了辅助治疗。中位随访5.9年，I期至IV期患者的5年无病生存率分别为78%、58%、27%和9%。在141例已知复发的患者中，复发的首发部位为远处38%、局部区域24%、腹膜20%，其余为多个部位。疾病分期、辅助治疗、淋巴结清扫范围、术后并发症和手术方式是长期生存的独立危险因素。
疾病分期、辅助治疗、淋巴结清扫范围、术后并发症和手术方式是长期生存的重要预测因素。进行充分且安全的手术以允许辅助治疗应是所有外科医生针对我们胃癌患者的目标。
