Estes N C, MacDonald J S, Touijer K, Benedetti J, Jacobson J
Department of Surgery, Kansas University School of Medicine, Kansas City, USA.
Am Surg. 1998 Jul;64(7):680-5.
Patients entered into Southwest Oncology Group gastric adjuvant protocol INT 0016 (SWOG 9008) after a "curative" gastric resection were assessed to determine practice patterns of more than 300 surgeons nationwide who performed "curative" gastric resections for 453 gastric cancer patients. The most common gastric resection performed was distal in 256 patients, proximal in 118, and total in 79. Extragastric organs resected were omentum (285), spleen (59), pancreas (18), and bowel (17). The extent of lymphadenectomy as staged by Japanese rules was 246 (54.2%) D0 resections, 173 (38.1%) D1 resections, 28 (6.2%) D2 resections, and 7 (1.5%) D3 resections. Staging of the cancer was poorly documented, with no statement made regarding the status of the primary cancer in 6 per cent, liver in 10 per cent, lymph nodes in 17 per cent, and omentum in 17 per cent. The greater the lymph node clearance, the greater the chance of resecting to a level of negative lymphatics, given that 45 per cent of nodes were involved when 10 or less were removed, whereas only 17 per cent were positive when more than 40 were cleared. The lack of adequate clearance of lymph nodes and poor documentation of tumor stage suggests that a more regimented surgical approach to this uncommon cancer is required.
入组西南肿瘤协作组胃癌辅助治疗方案INT 0016（SWOG 9008）的患者在接受“根治性”胃切除术后，对全国300多名为453例胃癌患者实施“根治性”胃切除术的外科医生的实践模式进行了评估。最常见的胃切除术为远端胃切除术（256例）、近端胃切除术（118例）和全胃切除术（79例）。切除的胃外器官包括大网膜（285例）、脾脏（59例）、胰腺（18例）和肠管（17例）。按照日本规则分期的淋巴结清扫范围为：D0切除246例（54.2%）、D1切除173例（38.1%）、D2切除28例（6.2%）、D3切除7例（1.5%）。癌症分期记录不完善，6%的患者未提及原发癌状态，10%未提及肝脏状态，17%未提及淋巴结状态，17%未提及大网膜状态。淋巴结清扫范围越大，切除至淋巴管阴性水平的机会就越大，因为切除10个或更少淋巴结时45%的淋巴结受累，而清扫超过40个淋巴结时只有17%为阳性。淋巴结清扫不充分以及肿瘤分期记录不完善表明，对于这种不常见的癌症需要采用更规范的手术方法。
