Chang Shih-Chun, Tang Chi-Ming, Le Puo-Hsien, Kuo Chia-Jung, Chen Tsung-Hsing, Wang Shang-Yu, Chou Wen-Chi, Chen Tse-Ching, Yeh Ta-Sen, Hsu Jun-Te
Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
Department of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
Cancers (Basel). 2021 Mar 14;13(6):1289. doi: 10.3390/cancers13061289.
Whether gastric adenocarcinoma (GC) patients with adjacent organ invasion (T4b) benefit from aggressive surgery involving pancreatic resection (PR) remains unclear. This study aimed to clarify the impact of PR on survival in patients with locally advanced resectable GC. Between 1995 and 2017, patients with locally advanced GC undergoing radical-intent gastrectomy with and without PR were enrolled and stratified into four groups: group 1 (G1), pT4b without pancreatic resection (PR); group 2 (G2), pT4b with PR; group 3 (G3), positive duodenal margins without Whipple's operation; and group 4 (G4), cT4b with Whipple's operation. Demographics, clinicopathological features, and outcomes were compared between G1 and G2 and G3 and G4. G2 patients were more likely to have perineural invasion than G1 patients (80.6% vs. 50%, < 0.001). G4 patients had higher lymph node yield (40.8 vs. 31.3, = 0.002), lower nodal status ( = 0.029), lower lymph node ratios (0.20 vs. 0.48, < 0.0001) and higher complication rates (45.2% vs. 26.3%, = 0.047) than G3 patients. The 5-year disease-free survival (DFS) and overall survival (OS) rates were significantly longer in G1 than in G2 (28.1% vs. 9.3%, = 0.003; 32% vs. 13%, = 0.004, respectively). The 5-year survival rates did not differ between G4 and G3 (DFS: 14% vs. 14.4%, = 0.384; OS: 12.6% vs. 16.4%, = 0.321, respectively). In conclusion, patients with T4b lesion who underwent PR had poorer survival than those who underwent resection of other adjacent organs. Further Whipple's operation did not improve survival in pT3-pT4 GC with positive duodenal margins.
胃腺癌（GC）伴有邻近器官侵犯（T4b）的患者是否能从包括胰腺切除（PR）的积极手术中获益仍不清楚。本研究旨在阐明PR对局部晚期可切除GC患者生存的影响。1995年至2017年，纳入接受根治性胃切除术且有或无PR的局部晚期GC患者，并将其分为四组：第1组（G1），pT4b且未行胰腺切除（PR）；第2组（G2），pT4b且行PR；第3组（G3），十二指肠切缘阳性且未行Whipple手术；第4组（G4），cT4b且行Whipple手术。比较G1与G2以及G3与G4之间的人口统计学、临床病理特征和结局。G2患者比G1患者更易发生神经周围侵犯（80.6%对50%，<0.001）。G4患者比G3患者有更高的淋巴结获取数（40.8对31.3，=0.002）、更低的淋巴结状态（=0.029）、更低的淋巴结比率（0.20对0.48，<0.0001）以及更高的并发症发生率（45.2%对26.3%，=0.047）。G1组的5年无病生存率（DFS）和总生存率（OS）显著长于G2组（分别为28.1%对9.3%，=0.003；32%对13%，=0.004）。G4组和G3组的5年生存率无差异（DFS：14%对14.4%，=0.384；OS：12.6%对16.4%，=0.321）。总之，行PR的T4b病变患者比行其他邻近器官切除的患者生存更差。对于十二指肠切缘阳性的pT3 - pT4 GC患者，进一步行Whipple手术并不能改善生存。
