Shchepotin I B, Chorny V A, Nauta R J, Shabahang M, Buras R R, Evans S R
Department of Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
Am J Surg. 1998 Feb;175(2):123-6. doi: 10.1016/S0002-9610(97)00268-7.
Some physicians still consider invasion of adjacent organs by the carcinoma of stomach as a sign of incurable disease.
This retrospective study has been done with particular reference to 353 T4 gastric cancer patients who underwent combined gastrectomies with adjacent organs.
Subtotal gastrectomy was performed in 237 (67.1%) patients and total gastrectomy was performed in 116 (32.9%) patients. Organs most commonly resected with the stomach were the transverse colon in 159 (45%) cases, the tail of pancreas and spleen in 150 (42.5%), the left lobe of liver in 101 (28.5%), and the head of pancreas in 37 (10.5%) patients. A total of 110 postoperative complications occurred in this subset of patients corresponding to a complication rate of 31.2%. A total of 48 postoperative deaths occurred in this subset of patients corresponding to a mortality rate of 13.6%. The 5-year survival rate for all patients who underwent combined gastrectomy with adjacent organs was 25%. Of the node-negative T4 gastric cancer resections, 37% survived 5 years whereas the T4 node-positive resections have only a 15% 5-year survival.
Patients who present with T4 gastric cancer (about 20% of the patient population) will benefit from aggressive en bloc surgical resection and should not be considered unresectable.
一些医生仍将胃癌侵犯相邻器官视为不治之症的标志。
本回顾性研究特别针对353例接受了与相邻器官联合胃切除术的T4期胃癌患者进行。
237例（67.1%）患者接受了胃次全切除术，116例（32.9%）患者接受了全胃切除术。最常与胃一起切除的器官是横结肠，共159例（45%）；胰尾和脾脏，共150例（42.5%）；肝左叶，共101例（28.5%）；胰头，共37例（10.5%）。该组患者共发生110例术后并发症，并发症发生率为31.2%。该组患者共发生48例术后死亡，死亡率为13.6%。所有接受与相邻器官联合胃切除术的患者5年生存率为25%。在淋巴结阴性的T4期胃癌切除术中，37%的患者存活了5年，而淋巴结阳性的T4期胃癌切除术患者5年生存率仅为15%。
患有T4期胃癌的患者（约占患者总数的20%）将从积极的整块手术切除中获益，不应被视为不可切除。
