Total versus subtotal gastrectomy - Surgical morbidity and mortality rates in a multicenter Italian randomized trial
Total versus subtotal gastrectomy - Surgical morbidity and mortality rates in a multicenter Italian randomized trial
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DOI：
10.1097/00000658-199711000-00006
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发表时间：
1997-11-01
影响因子：
9
通讯作者：
Gennari, L
中科院分区：
文献类型：
--
作者：
Bozzetti, F;Marubini, E;Gennari, L
目的本研究的目的是分析术后发病率和死亡率的患者包括在一项随机试验比较全胃切除术与次全胃切除术胃癌cancer.Summary背景资料有争议的最佳手术是否在远端一半的胃是次全胃切除术或全胃切除术。虽然只有一个随机试验可以解决这个肿瘤学的困境，第一步是证明是否这两个程序是惩罚不同的术后发病率和死亡率。方法共624例患者在远端一半的胃被随机胃大部切除术（320）或全胃切除术（304），都与二级淋巴结切除术，在一项旨在评估两种手术后肿瘤学结果的多中心试验中。考虑的终点是术后事件、并发症或死亡的发生以及术后住院时间。结果胃大部切除术患者中非致命性并发症和死亡的发生率分别为9%和1%，全胃切除术患者中非致命性并发症和死亡的发生率分别为13%和2%。对术后事件的多变量分析表明，脾切除术或邻近器官切除术与术后并发症的两倍风险相关。随机手术和手术时间延长影响住院时间。平均住院时间，调整手术的扩展，胃大部切除术和全胃切除术的15.4天，为13.8天。结论我们的数据显示，胃大部切除术和全胃切除术，第二层淋巴结清扫术，作为一个选择性的程序进行了类似的术后并发症发生率和手术结果。因此，对两种手术进行结论性的长期评价，并准确估计手术对长期生存的肿瘤学影响，而不因两种手术之一的过度手术风险而受到惩罚，是可行的。
Objective The purpose of this study was to analyze postoperative morbidity and mortality of patients included in a randomized trial comparing total versus subtotal gastrectomy for gastric cancer.Summary Background Data There is controversy as to whether the optimal surgery for gastric cancer in the distal half of the stomach is subtotal or total gastrectomy. Although only a randomized trial can resolve this oncologic dilemma, the first step is to demonstrate whether the two procedures are penalized by different postoperative morbidity and mortality rates.Methods A total of 624 patients with cancer in the distal half of the stomach were randomized to subtotal gastrectomy (320) or total gastrectomy (304), both associated with a second-level lymphadenectomy, in a multicenter trial aimed at assessing the oncologic outcome after the two procedures. The end points considered were the occurrence of a postoperative event, complication, or death and length of postoperative stay.Results Nonfatal complications and death occurred in 9% and 1% of subtotal gastrectomy patients and in 13% and 2% of total gastrectomy patients, respectively. Multivariate analysis of postoperative events showed that splenectomy or resection of adjacent organs was associated with a twofold risk of postoperative complications. Random surgery and extension of surgery influenced the length of stay. The mean length of stay, adjusted for extension of surgery, was 13.8 days for subtotal gastrectomy and 15.4 days for total gastrectomy.Conclusions Our data show that subtotal and total gastrectomies, with second-level lymphadenectomy, performed as an elective procedure have a similar postoperative complication rate and surgical outcome. A conclusive long-term evaluation of the two operations and an accurate estimate of the oncologic impact of surgery on long-term survival, not penalized by excess surgical risk of one of the two operations, are consequently feasible.