Fékété F, Sauvanet A, Berthoux L, Flejou J F, Gayet B
Service de Chirurgie Digestive, Université Paris VII, Faculté Xavier Bichat, Hôpital Beaujon, Clichy.
J Chir (Paris). 1997 Nov;134(5-6):202-8.
In the curative treatment of the adenocarcinoma of the cardia (AC), the extent of the esogastrectomy and the need for lymph node dissection are still debated. The palliative treatment of AC is now currently non-surgical. The aim of this study was (a): to assess early results of palliative surgery; and (b) to evaluate the results of curative resection with reference to the influence of the extent of gastrectomy and lymph node dissection on early results and long-term survival. Methods. From 1979 to 1989, 179 patients (mean age = 60 +/- 12 years) with AC had 45 palliative resections (mean age = 56 +/- 15) and 134 curative resections (mean age = 61 +/- 12). Thirty-eight proximal subtotal esogastrectomy (PSOG) and 7 total esogastrectomy (TOG) were palliative; 72 PSOG and 62 TOG extended to the spleen were curative and associated with lymphadenectomy.
The operative mortality rate was 8.9% regardless of the palliative or curative intent of resection. After palliative resection, the mortality rate was 2.6% (1/38) after PSOG and 42.9% (3/7) after OGT = (p = 0.01); the median survival was 8 months. After curative resection, the mortality rate was 12.5% (9/72) after PSOG and 4.8% (3/62) after extended TOG (p = 0.2); actuarial 5-year survival rate was 42% after PSOG and 39% after extended TOG.
These results suggests that: (a) palliative PSOG for AC can be performed with a low mortality; and (b) resection with extensive lymphadenectomy allows substantial survival regardless of the extent of gastrectomy.
在贲门腺癌（AC）的根治性治疗中，食管胃切除术的范围以及淋巴结清扫的必要性仍存在争议。目前AC的姑息性治疗主要是非手术治疗。本研究的目的是：（a）评估姑息性手术的早期结果；（b）参照胃切除术范围和淋巴结清扫对早期结果及长期生存的影响，评估根治性切除的结果。方法：1979年至1989年，179例AC患者（平均年龄=60±12岁）接受了45例姑息性切除术（平均年龄=56±15岁）和134例根治性切除术（平均年龄=61±12岁）。38例近端次全食管胃切除术（PSOG）和7例全食管胃切除术（TOG）为姑息性手术；72例PSOG和62例扩展至脾脏的TOG为根治性手术并伴有淋巴结清扫。
无论手术目的是姑息性还是根治性，手术死亡率均为8.9%。姑息性切除术后，PSOG术后死亡率为2.6%（1/38），OGT术后为42.9%（3/7）=（p=0.01）；中位生存期为8个月。根治性切除术后，PSOG术后死亡率为12.5%（9/72），扩展TOG术后为4.8%（3/62）（p=0.2）；PSOG术后5年精算生存率为42%，扩展TOG术后为39%。
这些结果表明：（a）AC的姑息性PSOG手术死亡率较低；（b）无论胃切除术范围如何，广泛淋巴结清扫的切除术可带来显著的生存获益。
