胃癌根治术中最佳近端切缘距离。
Optimal proximal resection margin distance for gastrectomy in advanced gastric cancer.
机构信息
Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea.
出版信息
World J Gastroenterol. 2020 May 14;26(18):2232-2246. doi: 10.3748/wjg.v26.i18.2232.
BACKGROUND
The conventional guidelines to obtain a safe proximal resection margin (PRM) of 5-6 cm during advanced gastric cancer (AGC) surgery are still applied by many surgeons across the world. Several recent studies have raised questions regarding the need for such extensive resection, but without reaching consensus. This study was designed to prove that the PRM distance does not affect the prognosis of patients who undergo gastrectomy for AGC.
AIM
To investigate the influence of the PRM distance on the prognosis of patients who underwent gastrectomy for AGC.
METHODS
Electronic medical records of 1518 patients who underwent curative gastrectomy for AGC between June 2004 and December 2007 at Asan Medical Center, a tertiary care center in Korea, were reviewed retrospectively for the study. The demographics and clinicopathologic outcomes were compared between patients who underwent surgery with different PRM distances using one-way ANOVA and Fisher's exact test for continuous and categorical variables, respectively. The influence of PRM on recurrence-free survival and overall survival were analyzed using Kaplan-Meier survival analysis and Cox proportional hazard analysis.
RESULTS
The median PRM distance was 4.8 cm and 3.5 cm in the distal gastrectomy (DG) and total gastrectomy (TG) groups, respectively. Patient cohorts in the DG and TG groups were subdivided into different groups according to the PRM distance; ≤ 1.0 cm, 1.1-3.0 cm, 3.1-5.0 cm and > 5.0 cm. The DG and TG groups showed no statistical difference in recurrence rate (23.5% 30.6% 24.0% 24.7%, 0.765) or local recurrence rate (5.9% 6.5% 8.4% 6.2%, = 0.727) according to the distance of PRM. In both groups, Kalpan-Meier analysis showed no statistical difference in recurrence-free survival ( = 0.467 in DG group; = 0.155 in TG group) or overall survival ( = 0.503 in DG group; = 0.155 in TG group) according to the PRM distance. Multivariate analysis using Cox proportional hazard model revealed that in both groups, there was no significant difference in recurrence-free survival according to the PRM distance.
CONCLUSION
The distance of PRM is not a prognostic factor for patients who undergo curative gastrectomy for AGC.
背景
在进展期胃癌（AGC）手术中，获得安全近端切缘（PRM）5-6cm 的传统指南仍然被世界各地的许多外科医生所采用。最近的几项研究对这种广泛切除的必要性提出了质疑，但尚未达成共识。本研究旨在证明 PRM 距离不会影响接受胃切除术的 AGC 患者的预后。
目的
探讨 PRM 距离对接受胃切除术的 AGC 患者预后的影响。
方法
回顾性分析 2004 年 6 月至 2007 年 12 月在韩国三级医疗中心 Asan 医疗中心接受根治性胃切除术的 1518 例 AGC 患者的电子病历，用于本研究。采用单因素方差分析和 Fisher 确切检验分别比较不同 PRM 距离手术患者的人口统计学和临床病理结局。采用 Kaplan-Meier 生存分析和 Cox 比例风险分析评估 PRM 对无复发生存和总生存的影响。
结果
远端胃切除术（DG）和全胃切除术（TG）组的 PRM 中位数分别为 4.8cm 和 3.5cm。DG 和 TG 组患者根据 PRM 距离进一步分为不同组；≤1.0cm、1.1-3.0cm、3.1-5.0cm 和>5.0cm。DG 和 TG 组根据 PRM 距离的远近，复发率（23.5%、30.6%、24.0%、24.7%、=0.765）或局部复发率（5.9%、6.5%、8.4%、6.2%、=0.727）均无统计学差异。在两组中，Kalpan-Meier 分析显示，根据 PRM 距离，无复发生存（DG 组=0.467；TG 组=0.155）或总生存（DG 组=0.503；TG 组=0.155）均无统计学差异。使用 Cox 比例风险模型的多变量分析显示，在两组中，根据 PRM 距离，无复发生存差异均无统计学意义。
结论
PRM 距离不是接受根治性胃切除术的 AGC 患者的预后因素。
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