基于早期胃癌前哨淋巴结概念的局部胃切除术后 PGSAS-45 对生活质量的评估。
Evaluation of postoperative quality of life by PGSAS-45 following local gastrectomy based on the sentinel lymph node concept in early gastric cancer.
机构信息
Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Department of Onco-Biological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
出版信息
Gastric Cancer. 2020 Jul;23(4):746-753. doi: 10.1007/s10120-020-01047-7. Epub 2020 Feb 21.
BACKGROUND
The usefulness of sentinel node navigation surgery (SNNS) for early gastric cancer has been demonstrated in a multicenter prospective study. However, quality of life (QOL) after local resection remains unclear. This present study investigated QOL after local resection and distal gastrectomy.
METHODS
We examined 69 patients who underwent laparoscopic distal gastrectomy (LADG) (n = 44) and laparoscopic local resection (LLR) (n = 25) in our hospital between September 2011 and May 2018. We conducted a combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) with SNNS as LLR. All patients had pStage I or II and none had received adjuvant chemotherapy. We evaluated QOL using the postgastrectomy syndrome assessment scale questionnaire (PGSAS-45) 1, 6, and 12 months after surgery.
RESULTS
In PGSAS-45, no significant differences were observed between LLR and LADG at 1 and 6 months after surgery. At 12 months, the LLR group scored better for some of the subscales (SS). In the endoscopic evaluation, the LLR group showed significant improvements in residual gastritis at 6 months (P = 0.006) and esophageal reflux and residual gastritis at 12 months (P = 0.021 and P = 0.017). A significant difference was observed in the prognostic nutritional index, which was assessed using serum samples, between the two groups at 6 months (P = 0.028). The body weight ratio was better in the LLR group than in the LADG group at 6 and 12 months (P = 0.041 and P = 0.007, respectively).
CONCLUSIONS
CLEAN-NET with SNNS preserved a better QOL and nutrition status than LADG in patients with early gastric cancer.
背景
在一项多中心前瞻性研究中，已经证明了前哨淋巴结导航手术（SNNS）对早期胃癌的有效性。然而，局部切除术后的生活质量（QOL）仍不清楚。本研究调查了局部切除术后和远端胃切除术后的 QOL。
方法
我们检查了 2011 年 9 月至 2018 年 5 月期间在我院接受腹腔镜远端胃切除术（LADG）（n=44）和腹腔镜局部切除术（LLR）（n=25）的 69 例患者。我们采用腹腔镜和内镜联合非暴露技术（CLEAN-NET）结合 SNNS 进行肿瘤的局部切除术。所有患者均为 pStage I 或 II 期，且均未接受辅助化疗。我们使用胃癌手术后综合征评估量表问卷（PGSAS-45）在手术后 1、6 和 12 个月评估 QOL。
结果
在 PGSAS-45 中，手术 1 个月和 6 个月后，LLR 和 LADG 之间没有显著差异。在 12 个月时，LLR 组在一些子量表（SS）上的评分更好。在内镜评估中，LLR 组在 6 个月时残胃炎明显改善（P=0.006），在 12 个月时食管反流和残胃炎明显改善（P=0.021 和 P=0.017）。两组在 6 个月时血清样本的预后营养指数（PNI）有显著差异（P=0.028）。LLR 组的体重比在 6 个月和 12 个月时优于 LADG 组（P=0.041 和 P=0.007）。
结论
与 LADG 相比，早期胃癌患者采用 SNNS 的 CLEAN-NET 保留了更好的 QOL 和营养状况。
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