Shinkai Masayuki, Imano Motohiro, Kohda Masashi, Nakanishi Tomoya, Hiraki Yoko, Hagi Takaomi, Kato Hiroaki, Shiraishi Osamu, Yasuda Atsushi, Tsubaki Masanobu, Nishida Shozo, Yasuda Takushi
Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
Division of Pharmacotherapy, Faculty of Pharmacy, Kindai University, Higashiosaka, Japan.
Langenbecks Arch Surg. 2023 Jul 31;408(1):291. doi: 10.1007/s00423-023-03028-7.
Gastric cancer patients with peritoneal metastasis (PM) are generally treated with systemic chemotherapy. When PM has disappeared because of chemotherapy, radical gastrectomy (so-called conversion surgery) is usually performed. We have previously reported the efficacy of conversion surgery, but there are no reports examining the efficacy of palliative gastrectomy for patients with residual PM after chemotherapy. The purpose of this study was to investigate the efficacy of palliative surgery for gastric cancer patients with PM who still have residual peritoneal dissemination after chemotherapy.
Twenty-five gastric cancer patients with PM confirmed by laparoscopy and who had received chemotherapy but who still had residual PM were included in this study. Among the 25 patients, palliative surgery was performed in 20 patients (PS group) and chemotherapy was continued in 5 patients (CTx group), and their therapeutic outcomes were compared.
In the PS group, total and distal gastrectomies were performed. Clavien-Dindo grade I postoperative complications occurred in two patients (10%). There were no treatment-related deaths. Postoperative chemotherapy was performed all cases. In the PS group, the median survival time (MST) reached 22.5 months, with 1- and 2-year overall survival (OS) rates of 95% and 45%, respectively, whereas in the CTx group, the MST was 15.8 months, and the 1- and 2-year OS rates were 60% and 0%, respectively. The PS group had significantly longer OS than the CTx group (P=0.044).
Palliative surgery is safe and may prolong survival in gastric cancer patients with residual PM after chemotherapy.
胃癌腹膜转移（PM）患者一般接受全身化疗。当PM因化疗而消失时，通常会进行根治性胃切除术（所谓的转化手术）。我们之前报道过转化手术的疗效，但尚无关于化疗后仍有PM残留患者的姑息性胃切除术疗效的报道。本研究的目的是探讨对化疗后仍有腹膜播散残留的胃癌PM患者进行姑息性手术的疗效。
本研究纳入了25例经腹腔镜证实有PM且接受过化疗但仍有PM残留的胃癌患者。在这25例患者中，20例患者接受了姑息性手术（PS组），5例患者继续化疗（CTx组），比较两组的治疗结果。
PS组进行了全胃切除术和远端胃切除术。2例患者（10%）发生了Clavien-Dindo I级术后并发症。无治疗相关死亡。所有病例均进行了术后化疗。PS组的中位生存时间（MST）为22.5个月，1年和2年总生存率（OS）分别为95%和45%，而CTx组的MST为15.8个月，1年和2年OS率分别为60%和0%。PS组的OS明显长于CTx组（P=0.044）。
姑息性手术是安全的，可能会延长化疗后仍有PM残留的胃癌患者的生存期。
