Liver and Peritonectomy Unit, St George Hospital, Sydney, Australia.
St George & Sutherland Clinical School, University of New South Wales, Sydney, Australia.
Ann Surg Oncol. 2019 Oct;26(11):3627-3635. doi: 10.1245/s10434-019-07510-9. Epub 2019 Jul 10.
This study was designed to assess the short- and long-term outcomes of gastric resection in cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for lower gastrointestinal (GI) malignancies.
Patients with adenocarcinoma and appendiceal mucinous neoplasms were included. Redo and incomplete cytoreductions were excluded. A total of 756 patients were identified. Of these, 65 underwent gastric resection, 11 underwent wedge, 43 distal, and 11 subtotal and total gastrectomy. Preoperative differences were assessed for and addressed with matching. Perioperative outcomes, overall survival (OS), and risk-free survival (RFS) were assessed in two analyses: first all gastric resections were included and the second excluded wedge resections. Subgroup analysis according to diagnosis subtype was conducted.
Demographic analysis revealed that markers of tumor aggression and poor nutrition were prevalent in the gastrectomy group. The matched analysis for gastric resections revealed higher rates of reoperation (38% vs. 22%, p = 0.028). After excluding wedge resections, increased rates of reoperation (40% vs. 22%, 0.019), grade 3/4 morbidity (76% vs. 59%, p = 0.036), and hospital stay (34 vs. 27 days, p = 0.012) were observed. For the unmatched cohort, OS (103 vs. 69 months, p = 0.501) and RFS (17 vs. 18 months, p = 0.181) for patients with CC = 0 were insignificantly different. In comparison for CC > 0, OS (31 vs. 83 months, p < 0.001) and RFS (9 vs. 20 months, p < 0.001) were significantly reduced in gastric resection. For the matched cohort, after excluding wedges, gastrectomy did not significantly decrease OS. However, RFS was decreased (11 vs. 20 months, p = 0.016).
Despite high postoperative morbidity, when complete cytoreduction is achieved, the need for gastric resection is not associated with inferior long-term outcomes.
本研究旨在评估胃肠道（GI）恶性肿瘤细胞减灭术（CRS）和腹腔内化疗（IPC）中胃切除术的短期和长期结果。
纳入腺癌和阑尾黏液性肿瘤患者。排除再次手术和不完全细胞减灭术。共确定了 756 名患者。其中 65 例行胃切除术，11 例行楔形切除术，43 例行远端胃切除术，11 例行胃次全切除术和全胃切除术。评估了术前差异并进行了匹配。在两种分析中评估了围手术期结局、总生存期（OS）和无复发生存期（RFS）：首先包括所有胃切除术，其次排除楔形切除术。根据诊断亚型进行亚组分析。
对患者进行了统计学分析，结果显示胃切除术组的肿瘤侵袭性和营养状况不良的标志物更为普遍。对胃切除术的匹配分析显示，再次手术的比例更高（38%比 22%，p=0.028）。排除楔形切除术组后，再次手术（40%比 22%，0.019）、3/4 级发病率（76%比 59%，p=0.036）和住院时间（34 比 27 天，p=0.012）的比例增加。对于未匹配的队列，CC=0 的患者的 OS（103 比 69 个月，p=0.501）和 RFS（17 比 18 个月，p=0.181）无显著差异。相比之下，CC>0 的患者 OS（31 比 83 个月，p<0.001）和 RFS（9 比 20 个月，p<0.001）明显降低。对于匹配的队列，排除楔形切除术组后，胃切除术并没有显著降低 OS。但是 RFS 降低（11 比 20 个月，p=0.016）。
尽管术后发病率较高，但当实现完全细胞减灭术时，胃切除术的需要与较差的长期结果无关。
