Sahakyan Mushegh А, Gabrielyan Artak, Petrosyan Hmayak, Yesayan Shushan, Shahbazyan Sevak S, Sahakyan Arthur M
Department of Surgery N1, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia.
Department of General and Laparoscopic Surgery, Central Clinical Military Hospital, Yerevan, Armenia.
J Gastrointest Cancer. 2020 Mar;51(1):135-143. doi: 10.1007/s12029-019-00222-z.
This study reports single-surgeon experience with extended gastrectomy including en-bloc resection of adjacent organs/structures for T4b stage gastric adenocarcinoma. Time-related changes in patient selection criteria and outcomes were also analyzed.
All consecutive gastrectomies for adenocarcinoma performed between May 2004 and December 2017 were extracted from prospectively collected database to study surgical and oncologic results. Time-related changes in outcomes were examined according to three time periods.
Five hundred eighty-seven gastrectomies were performed throughout the study period including 87 (14.8%) extended resections. The latter most often included pancreatosplenectomy, colon, and liver resections (21, 16, and 11 patients, respectively) resulting in similar postoperative outcomes and survival. Extended gastrectomy was associated with larger tumor size (8.4 vs 5.6 cm), performing total gastrectomy (55.2 vs 35.2%, p < 0.01) and increased blood loss (375 vs 150 ml, p < 0.01) compared with standard gastrectomy. Larger experience in extended gastrectomy allowed for expanding patient selection criteria, considering complex resections and extensive lymphadenectomy. Median and 3-year survival following extended gastrectomy for T4b adenocarcinoma were 14 months and 18%, respectively, which was comparable to standard gastrectomy for T4a adenocarcinoma (p = 0.48). Obesity, nodal stage and type of gastrectomy were associated with survival in T4b adenocarcinoma in the univariable analysis. Obesity and N3a and N3b stages were independent predictors in the multivariable model.
Extended gastrectomy for T4b gastric adenocarcinoma provides satisfactory surgical outcomes even with expanded patient selection criteria and regardless of the organ involved. Given its poor prognosis, neoadjuvant therapy should be considered to improve the long-term oncologic results.
本研究报告了单一外科医生进行扩大性胃切除术（包括整块切除T4b期胃腺癌的相邻器官/结构）的经验。还分析了患者选择标准和结果随时间的变化。
从前瞻性收集的数据库中提取2004年5月至2017年12月期间所有连续进行的腺癌胃切除术，以研究手术和肿瘤学结果。根据三个时间段检查结果随时间的变化。
在整个研究期间共进行了587例胃切除术，其中87例（14.8%）为扩大性切除术。后者最常包括胰脾切除术、结肠切除术和肝切除术（分别为21例、16例和11例患者），术后结果和生存率相似。与标准胃切除术相比，扩大性胃切除术与更大的肿瘤大小（8.4 vs 5.6 cm）、全胃切除术的实施率更高（55.2% vs 35.2%，p < 0.01）以及失血量增加（375 vs 140 ml，p < 0.01）相关。扩大性胃切除术的经验增多使得可以扩大患者选择标准，考虑复杂的切除术和广泛的淋巴结清扫术。T4b腺癌扩大性胃切除术后的中位生存期和3年生存率分别为14个月和18%，与T4a腺癌的标准胃切除术相当（p = 0.48）。在单变量分析中，肥胖、淋巴结分期和胃切除术类型与T4b腺癌的生存率相关。肥胖以及N3a和N3b期是多变量模型中的独立预测因素。
对于T4b期胃腺癌，即使扩大患者选择标准且不论涉及的器官如何，扩大性胃切除术也能提供令人满意的手术结果。鉴于其预后较差，应考虑新辅助治疗以改善长期肿瘤学结果。
