Wu C W, Hsieh M C, Lo S S, Wang L S, Hsu W H, Lui W Y, Huang M H, P'eng F K
Department of Surgery, Veterans General Hospital-Taipei, Republic of China.
J Am Coll Surg. 1995 Jul;181(1):26-32.
This study sought to analyze the morbidity and mortality rates after radical gastrectomy for carcinoma, since the operation has been criticized as too morbid for the benefits it may provide.
A prospective study of 474 patients who underwent radical gastrectomy was conducted.
The overall morbidity and mortality rates were 20.1 and 3.0 percent, respectively. The morbidity and mortality rates fell significantly from 27.0 to 15.7 percent (p = 0.003) and 5.5 to 1.1 percent (p < 0.001), respectively, after the first 200 cases. By logistic regression analysis, it was found that male gender, combined organ(s) resection, extended lymphadenectomy, respiratory system disease, and tumor location were significantly related to postoperative morbidity. In regard to the extent of lymphadenectomy, relative to R2 resection (n = 102), the odds ratio for morbidity after R3 resection (n = 217) was 2.13, and for R4 resection (n = 155) it was 3.12. Age older than 65 years, total gastrectomy, combined organ(s) resection, and respiratory system disease were factors that negatively affected operative mortality.
These observations suggested that radical gastrectomy can be performed with an acceptable risk of morbidity and mortality in a general hospital.
本研究旨在分析胃癌根治术后的发病率和死亡率，因为该手术因其可能带来的益处而被批评为过于致残。
对474例行胃癌根治术的患者进行了一项前瞻性研究。
总体发病率和死亡率分别为20.1%和3.0%。在前200例病例之后，发病率和死亡率分别从27.0%显著降至15.7%（p = 0.003）和从5.5%降至1.1%（p < 0.001）。通过逻辑回归分析发现，男性、联合器官切除、扩大淋巴结清扫、呼吸系统疾病和肿瘤位置与术后发病率显著相关。关于淋巴结清扫范围，相对于R2切除（n = 102），R3切除（n = 217）后发病的优势比为2.13，R4切除（n = 155）后发病的优势比为3.12。65岁以上、全胃切除、联合器官切除和呼吸系统疾病是对手术死亡率有负面影响的因素。
这些观察结果表明，在综合医院进行胃癌根治术时，发病率和死亡率的风险是可以接受的。
