Zhou Jin-Feng, Qiu Wei, Chen Jian-Sheng, Yan Bao-Quan, Feng Xiao-Hui, Xu Mei-Zhen, Yang Ji-Ping
Department of Laboratory Medicine, First Hospital of Putian, Putian 351100, Fujian Province, China.
World J Gastrointest Surg. 2025 Aug 27;17(8):109155. doi: 10.4240/wjgs.v17.i8.109155.
Gastric cancer (GC) is one of the most common malignancies and types of cancer worldwide.
To compare the differences in tumor markers of GC with GC dissection, we evaluated the efficacy of recent tumor removal.
A prospective cohort study was conducted to analyze the clinical data of patients with GC. Patients were divided into two groups based on the surgical approach: The membrane dissection (MD) group, which underwent membrane-guided laparoscopic radical gastrectomy with D2 lymph node dissection plus complete mesocolic excision, and the D2 group, which underwent traditional laparoscopic radical gastrectomy with D2 lymph node dissection. Abdominal lavage fluid was collected pre- and postoperatively from patients in both groups. The expression of carcinoembryonic antigen (CEA) and cytokeratin-19 (CK-19) message RNAs in the abdominal lavage fluid was detected using reverse transcription polymerase chain reaction. The factors influencing the increase of the tumor markers were analyzed, and the short-term efficacy of the two surgery types was compared.
In total, 135 eligible patients were included in this study, with 69 and 66 cases in the MD and D2 groups, respectively. Fourteen patients with benign gastric lesions were selected to detect tumor marker expression. After excluding patients positive for preoperative cancer leakage, we found that 9.52% and 26.67% of patients in the MD and D2 groups developed postoperative CEA positivity, respectively. Multivariate analysis revealed that the degree of differentiation and surgical approach were independent risk factors for postoperative CEA positivity. The surgical approach was an independent risk factor affecting postoperative CK-19 positivity and postoperative CEA and CK-19 positivity. Surgical time, intraoperative blood loss, number of lymph nodes dissected, time to first postoperative flatus, and time to first liquid intake were all significantly different between the two surgical approaches. There were no significant differences in the incision length, duration of postoperative hospital stays, or postoperative complications.
MD is a better radical surgical treatment than traditional D2 surgery and is worthy of further clinical promotion and application.
胃癌（GC）是全球最常见的恶性肿瘤和癌症类型之一。
为比较胃癌根治术患者肿瘤标志物的差异，我们评估了近期肿瘤切除的疗效。
进行一项前瞻性队列研究，分析胃癌患者的临床资料。根据手术方式将患者分为两组：膜解剖（MD）组，接受膜引导腹腔镜根治性胃切除术加D2淋巴结清扫及完整结肠系膜切除；D2组，接受传统腹腔镜根治性胃切除术加D2淋巴结清扫。两组患者术前和术后均采集腹腔灌洗液。采用逆转录聚合酶链反应检测腹腔灌洗液中癌胚抗原（CEA）和细胞角蛋白19（CK-19）信使RNA的表达。分析影响肿瘤标志物升高的因素，并比较两种手术方式的短期疗效。
本研究共纳入135例符合条件的患者，MD组和D2组分别为69例和66例。选取14例胃良性病变患者检测肿瘤标志物表达。排除术前癌漏阳性患者后，我们发现MD组和D2组术后CEA阳性率分别为9.52%和26.67%。多因素分析显示，分化程度和手术方式是术后CEA阳性的独立危险因素。手术方式是影响术后CK-19阳性及术后CEA和CK-19阳性的独立危险因素。两种手术方式在手术时间、术中出血量、清扫淋巴结数目、首次排气时间和首次进食时间方面均有显著差异。切口长度、术后住院时间或术后并发症方面无显著差异。
与传统D2手术相比，MD是一种更好的根治性手术治疗方法，值得进一步临床推广应用。
