Saito A, Korenaga D, Sakaguchi Y, Ohno S, Ichiyoshi Y, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Hepatogastroenterology. 1996 May-Jun;43(9):560-4.
BACKGROUND/AIMS: We have reviewed our experience with gastric cancer patients having synchronous liver metastasis in an attempt to clarify how to treat such patients.
In 116 patients with gastric cancer metastatic to the liver, evaluations were executed to find an effective treatment. Fourteen received gastrectomy plus hepatic resection (Group A), 68 gastrectomy alone (Group B), and 34 non-resected (Group C).
The average survival time was 15.0 months in Group A, 7.2 months in Group B and 3.6 months in Group C, with a statistical difference between Group B and Group C (p < 0.05). In Group A patients, the mean survival time was 21.5 months in those undergoing potentially curative surgery for the carcinoma without incurable factors other than liver metastasis. The survival time was 6.3 months in those undergoing noncurative gastrectomy and hepatectomy because of evidence of incurable metastatic spread, the value being similar to that following gastrectomy alone in Group B patients. In Group B, adjuvant chemotherapy led to a significant increase in survival (p < 0.05).
Hepatectomy combined with gastrectomy seems to be effective as an active measure to lengthen survival for patients of gastric carcinoma and concomitant liver metastasis only when other incurable factors were not evident at operation. Noncurative gastrectomy followed by adjuvant chemotherapy is recommended in the presence of various incurable factors.
背景/目的：我们回顾了胃癌伴同时性肝转移患者的治疗经验，旨在明确此类患者的治疗方法。
对116例发生肝转移的胃癌患者进行评估，以寻求有效的治疗方法。14例接受胃切除术加肝切除术（A组），68例仅接受胃切除术（B组），34例未接受手术（C组）。
A组的平均生存时间为15.0个月，B组为7.2个月，C组为3.6个月，B组和C组之间存在统计学差异（p < 0.05）。在A组患者中，对于除肝转移外无不可治愈因素的癌灶接受潜在根治性手术的患者，其平均生存时间为21.5个月。因存在不可治愈的转移扩散证据而接受非根治性胃切除术和肝切除术的患者，其生存时间为6.3个月，该值与B组仅接受胃切除术的患者相似。在B组中，辅助化疗使生存率显著提高（p < 0.05）。
仅当手术时无其他不可治愈因素时，肝切除术联合胃切除术似乎是延长胃癌伴肝转移患者生存时间的有效积极措施。存在各种不可治愈因素时，建议行非根治性胃切除术并辅以化疗。
