The Role of Extended Lymphadenectomy and Adjuvant Immunochemotherapy for Gastric Cancer

擴大淋巴廓清及輔助免疫化學治療對胃癌的意義

李威傑(Wei-Jei Lee) ； 魏達成(Ta-Cheng Wei) ； 游憲章(Sen-Chang Yu) ； 李伯皇(Po-Huang Lee) ； 張金堅(King-Jen Chang) ； 王世名(Shih-Ming Wang) ； 陳楷模(Kai-Mo Chen)

《慈濟醫學雜誌》 6卷3期 (1994/09) Pp. 153-161

https://doi.org/10.6440/TZUCMJ.199409.0153

摘要

To evaluate recent improvements in gastric cancer surgery, we performed a retrospective analysis of data from 482 patients who underwent primary gastrectomies from 1978 to 1987 (the recent group) and 264 patients who had been treated from 1965 to 1973 (the early group). Radical gastric resection with R2/3 lymphadenectomy was the standard procedure in the recent group as compared to a simple gastrectomy in the early group. In addition, postoperative long-term adjuvant immonochemotherapy with 5-fluorouracil, Mitomycin C, and PSK (Krestin) was given to 169 (35.1%) patients of the recent group. There were no significant differences in the characteristics of patients and location, stage or histological classification of gastric cancer between these two groups. Early gastric cancers accounted for 11.5% of the patients in the early group and 14.7% of the patients in the recent group. The resection rate increased from 57.8% to 686.7% and the 5-year survival rate increased from 24.7% to 37.9%. A comparison of patients with simple gastrectomies and those with radical gastrectomies showed a slight increase in the 5-year survival rate from 24.7% to 35.9% (p＜0.05). The advantage of radical resections was limited to patients at early stages and those with serosa invasion but without lymph node involvement. Patients who received adjuvant immunochemotherapy after radical gastrectomy had a 5-year survival rate of 41.5% an insignificant difference (p＞0.05) compared to 35.9% of those who received radical gastrectomy alone. However, fro patients with serosa invasion, combined adjuvant immunochemotherapy after curative resction was associated with an increased survival rate from 37.8% to 63.9% (p＜0.05). For patients with lymph node involvement, adjuvant immunochemotherapy was also associated with an increased survival rate from 10.4% to 26.4% (p＜0.01). In conclusion, the survival of gastric cancer patient after surgery appeared to have improved recently. The advantages of the radical gastrectomy seemed limited fro patients at an early stage, especially for those without lymph node involvement. For patients with advanced gastric cancer with serosa and lymph node involvement, adjuvant immunochemotherapy may be beneficial in addition to extended lymphadenectomy. Further randomized, controlled trials are warranted to clarify these issues. (Tzu Chi Med J 1994;6: 153-161)

關鍵字

胃癌 ； 擴大淋巴廓清 ； 輔助化學治療

並列摘要

To evaluate recent improvements in gastric cancer surgery, we performed a retrospective analysis of data from 482 patients who underwent primary gastrectomies from 1978 to 1987 (the recent group) and 264 patients who had been treated from 1965 to 1973 (the early group). Radical gastric resection with R2/3 lymphadenectomy was the standard procedure in the recent group as compared to a simple gastrectomy in the early group. In addition, postoperative long-term adjuvant immonochemotherapy with 5-fluorouracil, Mitomycin C, and PSK (Krestin) was given to 169 (35.1%) patients of the recent group. There were no significant differences in the characteristics of patients and location, stage or histological classification of gastric cancer between these two groups. Early gastric cancers accounted for 11.5% of the patients in the early group and 14.7% of the patients in the recent group. The resection rate increased from 57.8% to 686.7% and the 5-year survival rate increased from 24.7% to 37.9%. A comparison of patients with simple gastrectomies and those with radical gastrectomies showed a slight increase in the 5-year survival rate from 24.7% to 35.9% (p＜0.05). The advantage of radical resections was limited to patients at early stages and those with serosa invasion but without lymph node involvement. Patients who received adjuvant immunochemotherapy after radical gastrectomy had a 5-year survival rate of 41.5% an insignificant difference (p＞0.05) compared to 35.9% of those who received radical gastrectomy alone. However, fro patients with serosa invasion, combined adjuvant immunochemotherapy after curative resction was associated with an increased survival rate from 37.8% to 63.9% (p＜0.05). For patients with lymph node involvement, adjuvant immunochemotherapy was also associated with an increased survival rate from 10.4% to 26.4% (p＜0.01). In conclusion, the survival of gastric cancer patient after surgery appeared to have improved recently. The advantages of the radical gastrectomy seemed limited fro patients at an early stage, especially for those without lymph node involvement. For patients with advanced gastric cancer with serosa and lymph node involvement, adjuvant immunochemotherapy may be beneficial in addition to extended lymphadenectomy. Further randomized, controlled trials are warranted to clarify these issues. (Tzu Chi Med J 1994;6: 153-161)

並列關鍵字

gastric cancer ； extended lymph node dissection ； adjuvant chemotherapy