Kodama I, Takamiya H, Mizutani K, Ohta J, Aoyagi K, Kofuji K, Takeda J, Shirouzu K
First Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
J Am Coll Surg. 1997 Jan;184(1):16-22.
Carcinoma of the stomach invading one or more adjacent organs raises serious concerns over en bloc dissection because en bloc resection has an associated high risk and such advanced carcinoma is frequently associated with incurable factors. Thus, it is important to understand the efficacy of gastrectomy combined with other organ resection and to refine the indications for en bloc dissection.
Seventy-seven patients with carcinoma of the stomach directly invading adjacent organs or structures were analyzed retrospectively to investigate the efficacy of en bloc resection. Forty-one patients underwent gastrectomy combined with resection of one or more invaded organs (combined resection group), while the other 36 patients underwent gastrectomy with palliative abrasion between the primary tumor and the invasion site (noncombined resection group).
The five-year survival rate was 23 percent in the combined resection group and 0 percent in the noncombined resection group (p < .05). The 23 curative cases and 18 noncurative cases in the combined resection group had a survival rate of 41 percent and 0 percent, respectively (p < .05). The survival rate after a single organ resection was 29 percent, and after a multiple organ resection, 0 percent (p < .05). Cases of carcinoma invading either the pancreas or mesocolon had a slightly but not significantly better prognosis. In Borrmann type IV carcinoma there was no difference in survival between the curative and noncurative operation. Cases with P1 dissemination had a better prognosis than those of P2 and P3 dissemination.
The best indication for an en bloc combined organ resection was an invasion limited to only one other organ, not more than N2, no incurable factor, and any type except Borrmann type IV. Additionally, an en bloc combined resection would be worth trying for any type of gastric carcinoma with not more than P1 dissemination and with no other incurable factor.
侵犯一个或多个相邻器官的胃癌引发了对整块切除的严重担忧，因为整块切除具有较高风险，且这种进展期癌常伴有不可治愈因素。因此，了解胃切除术联合其他器官切除的疗效并完善整块切除的适应证很重要。
对77例胃癌直接侵犯相邻器官或结构的患者进行回顾性分析，以研究整块切除的疗效。41例患者接受胃切除术联合一个或多个受侵器官的切除（联合切除组），而其他36例患者接受胃切除术，在原发肿瘤和侵犯部位之间进行姑息性刮除（非联合切除组）。
联合切除组的五年生存率为23%，非联合切除组为0%（p < 0.05）。联合切除组的23例治愈病例和18例未治愈病例的生存率分别为41%和0%（p < 0.05）。单器官切除后的生存率为29%，多器官切除后为0%（p < 0.05）。侵犯胰腺或结肠系膜的病例预后略好但无显著差异。在Borrmann IV型癌中，根治性手术和非根治性手术的生存率无差异。P1播散的病例比P2和P3播散的病例预后更好。
整块联合器官切除的最佳适应证是侵犯仅限于另一个器官、不超过N2、无不可治愈因素且除Borrmann IV型外的任何类型。此外，对于任何P1播散且无其他不可治愈因素的胃癌，整块联合切除都值得尝试。
