Yonemura Y, Segawa M, Matsumoto H, Tsugawa K, Ninomiya I, Fonseca L, Fujimura T, Sugiyama K, Miwa K, Miyazaki I
Second Department of Surgery, Kanazawa University, School of Medicine, Ishikawa, Japan.
Surg Today. 1994;24(6):488-93. doi: 10.1007/BF01884566.
Because gastric cancers located in the upper third of the stomach are difficult to detect at an early stage, the surgical results remain poor. We performed R4 gastrectomy as a radical procedure for 25 patients, involving complete resection of the latero-aortic and interaorticovenous lymph modes above and below the left renal vein, in combination with the ordinary R2 or R3 gastrectomy (the R4 group). These patients were compared with 156 others who underwent R2 gastrectomy alone (the R2 group). There were no significant differences in operation time, blood loss, or the incidence of complications between the two groups; however, when the survival rates of the patients with tumors invading beyond the subserosa were compared, the 5-year survival rate was found to be significantly higher in the R4 group than in the R2 group. Furthermore, in patients with para-aortic nodal involvement, a significant survival advantage was observed in the R4 group, as compared with the R2 group. These results suggest that the R4 gastrectomy is a rational approach for patients with advanced gastric cancer located in the upper third of the stomach.
由于位于胃上三分之一处的胃癌在早期难以检测到，手术结果仍然较差。我们对25例患者实施了R4胃切除术作为根治性手术，包括完整切除左肾静脉上下的主动脉旁和主动脉静脉间淋巴结组，同时结合普通的R2或R3胃切除术（R4组）。将这些患者与另外156例仅接受R2胃切除术的患者（R2组）进行比较。两组在手术时间、失血量或并发症发生率方面无显著差异；然而，当比较肿瘤侵犯超过浆膜下层的患者的生存率时，发现R4组的5年生存率显著高于R2组。此外，在有主动脉旁淋巴结受累的患者中，与R2组相比，R4组观察到显著的生存优势。这些结果表明，R4胃切除术是治疗位于胃上三分之一处的进展期胃癌患者的一种合理方法。
