Center for Gastric Cancer, National Cancer Center, Ilsan-ro 323, Ilsandong-gu, Goyang-si, 10408, Republic of Korea.
World J Surg Oncol. 2022 Sep 26;20(1):311. doi: 10.1186/s12957-022-02780-2.
Additional surgery is recommended after non-curative endoscopic submucosal dissection for early gastric cancer. However, it is not easy to recommend for tumors located in the upper third of the stomach, because it would be a total or proximal gastrectomy. This study aimed to evaluate the actual risks and benefits of additional gastrectomy for upper third tumors.
We reviewed the clinicopathological data of patients who underwent total or proximal gastrectomy for early gastric cancer in the upper third of the stomach between March 2002 and January 2021. The incidence of lymph node metastasis and postoperative complications were calculated, and risk factors for lymph node metastasis were identified using logistic regression analysis. Survival rates were analyzed using the Kaplan-Meier method and log-rank test.
A total of 523 patients underwent total or proximal gastrectomy for early gastric cancer; 379 of them had tumors meeting the non-curative resection criteria for endoscopic submucosal dissection. The overall lymph node metastasis rate was 9.5%, and lymphovascular invasion was the only significant risk factor for lymph node metastasis (p < 0.001). The most common sites of lymph node metastasis were stations 1, 3, and 7, with their rates being 3.2%, 3.7%, and 3.2%, respectively. Overall and severe (Clavien-Dindo grade III or higher) postoperative complication rates were 21.1% and 14.0%, respectively, while postoperative mortality was 0.5% (2/379). The 5-year overall survival rates for patients with and without lymph node metastasis were 96.1% and 81.1%, respectively (p = 0.076).
Before planning an additional gastrectomy after non-curative endoscopic resection for the upper third tumor, we should consider both the benefit of the 9.5% curability for lymph node metastasis and the risks of the 21% postoperative complications and 0.5% mortality.
对于早期胃癌，内镜黏膜下剥离术非治愈性切除后建议追加手术。然而，对于位于胃上部的肿瘤，由于需要进行全胃或近端胃切除术，因此推荐手术并不容易。本研究旨在评估追加胃切除术治疗胃上部肿瘤的实际风险和获益。
我们回顾了 2002 年 3 月至 2021 年 1 月期间因胃上部早期胃癌接受全胃或近端胃切除术的患者的临床病理资料。计算了淋巴结转移的发生率和术后并发症，并使用 logistic 回归分析确定了淋巴结转移的危险因素。使用 Kaplan-Meier 方法和对数秩检验分析生存率。
共 523 例患者因早期胃癌行全胃或近端胃切除术，其中 379 例肿瘤符合内镜黏膜下剥离术非治愈性切除标准。总的淋巴结转移率为 9.5%，血管淋巴管侵犯是淋巴结转移的唯一显著危险因素（p<0.001）。淋巴结转移最常见的部位是 1、3 和 7 站，其转移率分别为 3.2%、3.7%和 3.2%。总的和严重（Clavien-Dindo 分级 III 级或更高）术后并发症发生率分别为 21.1%和 14.0%，而术后死亡率为 0.5%（2/379）。有淋巴结转移和无淋巴结转移患者的 5 年总生存率分别为 96.1%和 81.1%（p=0.076）。
在计划对非治愈性内镜切除后的上部肿瘤进行追加胃切除术前，我们应考虑淋巴结转移的 9.5%治愈率和 21%的术后并发症发生率及 0.5%的死亡率这两方面的获益和风险。
