Viste A, Svanes K, Janssen C W, Maartmann-Moe H, Søreide O
Department of Surgery, University of Bergen, Norway.
Eur J Surg. 1994 Sep;160(9):497-502.
To evaluate the effect of extensive lymphadenectomy on survival in patients with gastric cancer.
Retrospective analysis
University Hospital, Norway.
183 patients with stomach cancer resected for cure during the time period 1980-90.
78 patients had an R1- and 105 patients and R2 resection. 124 patients were treated by total gastrectomy, 5 by proximal--and 54 by distal resection.
Morbidity, mortality and long term survival.
The morbidity was 33% (60/183), of which 39 (21%) were general complications (pneumonia, thrombosis, or cardiovascular disease). 14 patients died postoperatively (8%). By logistic regression analysis we found that splenectomy was the only variable associated with both morbidity and immediate postoperative mortality. Five year survival was 39% for patients who had undergone curative resections, 30% for patients who had had an R1 resection, and 47% for those who had had an R2 resection. By multivariate analysis (Cox) we found that N-classification (TNM), tumour diameter of less than 45 mm, type of lymph node dissection (R2) and operation period (after 1984) correlated with improved survival.
Extensive lymph node dissection improves survival without increasing morbidity or postoperative mortality.
评估广泛淋巴结清扫术对胃癌患者生存率的影响。
回顾性分析
挪威大学医院
1980年至1990年间因治愈目的而行胃癌切除术的183例患者。
78例行R1切除，105例行R2切除。124例行全胃切除术，5例行近端胃切除术，54例行远端胃切除术。
发病率、死亡率和长期生存率。
发病率为33%（60/183），其中39例（21%）为全身并发症（肺炎、血栓形成或心血管疾病）。14例患者术后死亡（8%）。通过逻辑回归分析，我们发现脾切除术是与发病率和术后即刻死亡率均相关的唯一变量。根治性切除患者的五年生存率为39%，R1切除患者为30%，R2切除患者为47%。通过多因素分析（Cox法），我们发现N分期（TNM）、肿瘤直径小于45mm、淋巴结清扫类型（R2）和手术时间（1984年后）与生存率提高相关。
广泛淋巴结清扫术可提高生存率，且不增加发病率或术后死亡率。
