Surgery for Gastric Cancer: A 1154 Patients Experience

1154例胃癌手術的治療結果

蔡孟叡(Meng-Jui Tsai) ； 李孟達(Meng-Dar Lee) ； 羅永男(Yung-Nan Luo) ； 劉茂和(Mao-Ho Liu) ； 林光洋(Kuang-Yang Lin) ； 王鐘貴(Chung-Kwe Wang)

《北市醫學雜誌》 3卷6期 (2006/06) Pp. 606-619

https://doi.org/10.6200/TCMJ.2006.3.6.09

摘要

目的：關於胃癌治療的爭議，仍存在於胃癌淋巴腺清除的範圍，何者可得到最佳的治療結果及最正確的分期。本研究之目的是要比較廣泛性淋巴腺清除與局限性淋巴腺清除在存活率與死亡率上的差異。方法：我們分析1154位1974年到2000年之間在本院接受胃癌手術的病人，其中901位為治癒性切除。病人分為三群：A組為D2(第二群淋巴腺清除之治癒性切除)，B組為D1(第一群淋巴腺清除之治癒性切除)，C組為非治癒性切除。我們分析其臨床及病理特徵和生存率。結果：全部病人的五年生存率為47.4%。A，B，C三組病人的五年生存率分別是61.6%，42.1%，1.7%。分期之五年生存率為Ia期95.5%，Ⅰb期78.4%，Ⅱ期，64.5%。Ⅲ期，29.9%；Ⅳ期，4.8%。術後死亡率分別為：A組1.5%；B組3.9%；C組4%。結論：在本研究中，根治性胃切除併廣泛淋巴腺清除術治療胃癌病得到和日本相近的成績，而且死亡率相當低。我們的經驗顯示對於可能治癒性切除之胃癌施行標準D2淋巴腺清除術比較局限性淋巴腺清除可以得到較好的治療成果。

關鍵字

胃癌 ； 廣泛淋巴腺清除

並列摘要

Background and Purpose: The major controversy for surgical treatment of gastric cancer now is in regard to the extent of lymph node dissection necessary to achieve a best chance of cure and an accurate staging. This study was aimed to compare the difference in survival and postoperative mortality between extended lymphadenectomy and limited lymphadenectomy. Methods: We retrospectively assessed 1154 patients who underwent total or subtotal gastrectomy for primary gastric cancer in the department of gastrointestinal surgery of Renai hospital between 1974 and 2000. 901 of them were treated with potentially curative resection. The patients were divided into three groups (group A: R0D2; group B: R0 D1 or D1+; group C: noncurative). The clinical and pathologic characteristics and survival difference were analyzed. Results: Five-year survival rate for all patients was 47.4 %. The 5-year survival rates for the patients of group A, B and C were 61.6%, 42.1% and 1.7%, respectively. The 5-year survival rates related to stage were: Stage Ⅰa, 95.5%; Stage Ⅰb78.4%; Stage Ⅱ, 64.5%; Stage Ⅲ, 29.9%; Stage Ⅳ, 4.8%. Postoperative hospital mortality totaled 2.3% (26/1154). The rate for group A patients was 1.5% (12/801). Postoperative hospital mortality rates were 3.9% (4/103) for group B patients and 4% (10/250) for group C patients. Conclusion: Radical gastrectomy with extended lymph node dissection in this study had survival rates similar to the Japanese investigations with a low postoperative mortality. Our results showed that extended (D2) gastrectomy had a superior survival result than the limited lymphadenectomy and should be the better option for advanced gastric cancer that is potentially resectable.

並列關鍵字

gastric cancer ； extended lymph node dissection