Polkowski W, Ciechański A, Wallner G, Dabrowski A, Pawłowski A, Chibowski D, Misiuna P
Kliniki Chirurgii Ogólnej II Katedry Chirurgii, Akademii Medycznej w Lublinie.
Wiad Lek. 1997;50 Suppl 1 Pt 2:388-93.
Increasing prevalence of adenocarcinoma of the esophagus and esophago-gastric junction has been reported. The aim of the study was to determine whether this phenomenon is reflected in the cohort of patients referred for surgery to our institution. Clinical and pathological records of patients with adenocarcinoma of the stomach (n = 433) or gastro-esophageal junction (n = 302), and squamous cell carcinoma of the esophagus (n = 266) were reviewed from 1981 to 1996. Yearly prevalence of carcinoma of the gastric cardia in comparison to carcinoma of (a more distal) stomach has not changed, ranging 19-46%. From 1981 to 1984 out of 58 gastric resections, 14 (24%) total gastrectomies were done, whereas from 1993 to 1996 total gastrectomies were performed in 104 out of 138 (75%) patients with gastric cancer (p < 0.001). In the first 4 years of the study period adenocarcinoma of the cardia and/or esophagus was found in 19% of all patients with esophageal and junctional tumors, while in the last 4 years,-in 30%. Resection rates for gastric and cardiac cancers have not changed significantly, 75-100% and 21-65% respectively. Resection rate for carcinoma of the esophagus increased from 50% (17/34) to 79% (53/67) (p = 0.006, test chi2). Increasing rate of total gastrectomies can be explained by a trend towards more proximal localisation of the primary gastric tumors and/or clinical application of Laurén classification for the choice of operative procedure. Higher resection rate for carcinoma of the esophagus is a result of increasing experience of the surgical team, improvement in preoperative staging, new palliative modalities, and application of preoperative chemo-/radiotherapy.
据报道，食管腺癌和食管胃交界腺癌的患病率呈上升趋势。本研究的目的是确定这一现象在转诊至我院接受手术的患者队列中是否有所体现。回顾了1981年至1996年期间胃癌（n = 433）、胃食管交界癌（n = 302）和食管鳞状细胞癌（n = 266）患者的临床和病理记录。与（更远端的）胃癌相比，贲门癌的年患病率没有变化，范围在19%至46%之间。1981年至1984年期间，在58例胃切除术中，有14例（24%）进行了全胃切除术，而1993年至1996年期间，138例胃癌患者中有104例（75%）进行了全胃切除术（p < 0.001）。在研究期的前4年，所有食管和交界性肿瘤患者中有19%发现了贲门和/或食管癌，而在最后4年，这一比例为30%。胃癌和贲门癌的切除率没有显著变化，分别为75% - 100%和21% - 65%。食管癌的切除率从50%（17/34）提高到了79%（53/67）（p = 0.006，卡方检验）。全胃切除术比例的增加可以用原发性胃肿瘤向更靠近端定位的趋势和/或在选择手术方式时采用Laurén分类法的临床应用来解释。食管癌切除率的提高是手术团队经验增加、术前分期改善、新的姑息治疗方式以及术前放化疗应用的结果。
