Isozaki H, Okajima K, Ichinona T, Fujii K, Nomura E, Izumi N
Department of Surgery, Osaka Medical College, Japan.
Surg Today. 1997;27(1):17-21. doi: 10.1007/BF01366934.
To clarify the therapeutic strategies for gastric cancer surgery in the presence of cirrhosis, 39 patients with gastric cancer accompanied by liver cirrhosis were reviewed. Severe postoperative complications developed in 10 patients (25.6%), and there were 4 (10.3%) hospital deaths. 1 (2.6%) of which occurred within 1 month. Although extended lymph node dissection of D2 or more was adopted for low-risk patients, 3 of 19 patients who underwent such extensive operations, most of which involved complete lymph node dissection in the hepatoduodenal ligament, died. Conversely, only 1 of 20 patients who underwent limited lymph node dissection of D1 or less died. Postoperative massive ascites developed in 6 patients, 3 of whom died. The cumulative 5-year survival rate following curative resection was 63.7% for patients with early gastric cancer, and 13.9% for those with advanced gastric cancer. The most frequent cause of death was cirrhosis-related, such as hepatic failure or hepatoma. In conclusion, extensive lymph node dissection for patients with gastric cancer accompanied by cirrhosis carried a risk of postoperative fatal massive ascites as lymphorrhea. Thus, lymph node dissection in the hepatoduodenal ligament should be avoided, except in patients with evident metastases, and as a rule, aggressive surgery should not be performed in cirrhotic patients.
为阐明存在肝硬化时胃癌手术的治疗策略，对39例伴有肝硬化的胃癌患者进行了回顾性研究。10例患者（25.6%）出现严重术后并发症，4例（10.3%）患者死亡，其中1例（2.6%）在1个月内死亡。尽管对低风险患者采用了D2或更广泛的淋巴结清扫术，但19例接受此类广泛手术的患者中有3例死亡，其中大多数手术涉及肝十二指肠韧带的完全淋巴结清扫。相反，20例接受D1或更少的有限淋巴结清扫术的患者中只有1例死亡。6例患者术后出现大量腹水，其中3例死亡。早期胃癌患者根治性切除后的累积5年生存率为63.7%，晚期胃癌患者为13.9%。最常见的死亡原因与肝硬化相关，如肝衰竭或肝癌。总之，伴有肝硬化的胃癌患者进行广泛淋巴结清扫术有术后因淋巴漏导致致命性大量腹水的风险。因此，除有明显转移的患者外，应避免在肝十二指肠韧带进行淋巴结清扫，一般而言，不应在肝硬化患者中进行激进手术。
