Schweizer W, Reinhart A, Wagner H E, Hassler H, Scheurer U
Department of Visceral and Transplantation Surgery, University of Berne, Switzerland.
Int Surg. 1995 Jul-Sep;80(3):204-7.
We compared preoperative (combined clinical and radiological staging and endoscopical Borrmann classification), intraoperative (by the surgeon: curative/palliative; R0/R1/R2-resection; intraoperative stage I to IV) and postoperative staging including histological results (pTNM) in respect of resectability and prognosis.
All patients with adenocarcinoma of the stomach were prospectively and consecutively included in the study protocol and were staged during the hospitalisation by the different specialists. Out of 215 patients with malignant tumors of the stomach, 153 were finally evaluated for the study. We excluded 62 patients with other malignancies or with a follow up of less than 6 months. Preoperative endoscopic Borrmann classification was done by the gastroenterologist, preoperative TNM-classification by the radiologist and surgeon, intraoperative classification by the surgeon and postoperative classification by the pathologist. All results were immediately described in the protocol. Follow-up and survival curves were performed by the Regional Tumor Registry and statistics by the Statistical Department of the University using Kaplan-Meier survival curves and Log-Rank and Wilcoxon Test for significance.
Preoperative staging was unreliable and there was no relationship between preoperative and postoperative staging nor survival. In opposite intra- and postoperative staging correlated significantly between the different groups and with survival (p < 0.001).
As long as preoperative staging systems are not improved (which may be in the future the case with endosonography), all operable patients with gastric carcinoma should undergo a laparotomy or laparoscopy, because only intraoperative evaluation of the surgeon allows a decision on a possible curative resection. Patients with stages I-III should be resected radically with complete dissection of lymph node compartments 1 and 2. This policy is justified especially in view of a minimal hospital mortality (3%).
我们比较了术前（临床与影像学联合分期及内镜下Borrmann分类）、术中（由外科医生判断：根治性/姑息性；R0/R1/R2切除；术中分期为I至IV期）以及术后分期（包括组织学结果，即pTNM）在可切除性和预后方面的情况。
所有胃癌患者均前瞻性、连续纳入研究方案，并在住院期间由不同专科医生进行分期。在215例胃恶性肿瘤患者中，最终153例纳入本研究评估。我们排除了62例患有其他恶性肿瘤或随访时间少于6个月的患者。术前内镜下Borrmann分类由胃肠病学家完成，术前TNM分类由放射科医生和外科医生完成，术中分类由外科医生完成，术后分类由病理学家完成。所有结果均立即记录在方案中。随访和生存曲线由地区肿瘤登记处绘制，统计学分析由大学统计部门使用Kaplan-Meier生存曲线以及Log-Rank和Wilcoxon检验进行显著性分析。
术前分期不可靠，术前与术后分期及生存之间均无关联。相反，不同组之间术中与术后分期显著相关，且与生存相关（p<0.001）。
只要术前分期系统没有改进（未来超声内镜可能会改进），所有可手术的胃癌患者均应接受剖腹手术或腹腔镜检查，因为只有外科医生的术中评估才能决定是否可行根治性切除。I-III期患者应进行根治性切除，彻底清扫第1和第2组淋巴结。鉴于最低的医院死亡率（3%），这一策略尤其合理。
