Attempted Salvage Resection for Recurrent Gastric or Gastroesophageal Cancer
Attempted Salvage Resection for Recurrent Gastric or Gastroesophageal Cancer
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DOI：
10.1245/s10434-008-0210-x
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发表时间：
2009-01-01
影响因子：
3.7
通讯作者：
Mansfield, Paul
中科院分区：
文献类型：
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作者：
Badgwell, Brian;Cormier, Janice N.;Mansfield, Paul
本研究的目的是确定复发性胃癌或胃食管癌患者的手术结果。我们查询了1973年至2005年来我院就诊的7,459例胃癌或胃食管癌患者的记录，以确定那些曾尝试切除复发性疾病的患者。我们用逻辑回归分析评估了各种临床病理因素与可切除性之间的关系，用考克斯比例风险模型评估了临床病理因素与总生存期（OS）之间的关系。60例患者因复发性癌症接受了尝试切除术。在31例（52%）中，复发性疾病在剖腹手术中证明不可切除。与再次切除能力相关的因素包括初次切除前的新辅助治疗[比值比（OR）12.2，95%置信区间（CI）1.9-75.6]和孤立性局部复发（OR 5.1，95% CI 1.3-20.5）。在29例再次切除的患者中，14例需要切除邻近器官，6例需要间置移植。所有60例患者的3年和5年OS率分别为21%和12%;中位随访时间为23个月。接受切除术患者的中位OS为25.8个月（95% CI 17.1-49.8），而不可切除患者的中位OS为6.0个月（95% CI 4.0-10.5）（P < 0.001）。胃食管交界处的初始肿瘤位置与OS降低相关[风险比（HR）2.8，95% CI 1.2-6.5]，接受复发切除术的能力与OS改善相关（HR 0.2，95% CI 0.1-0.6）。我们的结论是，选择性手术切除复发性胃癌或胃食管癌患者可以改善OS，但通常需要切除邻近器官或插入移植物放置。
The purpose of this study was to determine the outcome of surgery for patients with recurrent gastric or gastroesophageal cancer. We queried records from 7,459 patients who presented with gastric or gastroesophageal cancer to our institution from 1973 through 2005 to identify those for whom resection of recurrent disease had been attempted. We assessed the associations between various clinicopathologic factors and resectability with logistic regression analysis and between clinicopathologic factors and overall survival (OS) with the Cox proportional hazards model. Sixty patients underwent attempted resection for recurrent cancer. In 31 cases (52%), recurrent disease proved unresectable at laparotomy. Factors associated with the ability to undergo re-resection included neoadjuvant treatment prior to initial resection [odds ratio (OR) 12.2, 95% confidence interval (CI) 1.9-75.6] and having an isolated local recurrence (OR 5.1, 95% CI 1.3-20.5). Of the 29 patients who underwent re-resection, 14 required adjacent organ resection, and 6 required interposition grafting. Three- and 5-year OS rates for all 60 patients were 21% and 12%, respectively; median follow-up time was 23 months. Median OS for patients undergoing resection was 25.8 months (95% CI 17.1-49.8) versus 6.0 months (95% CI 4.0-10.5) for unresectable patients (P < 0.001). Initial tumor location at the gastroesophageal junction was associated with diminished OS [hazard ratio (HR) 2.8, 95% CI 1.2-6.5] and ability to undergo resection of recurrence was associated with improved OS (HR 0.2, 95% CI 0.1-0.6). We conclude that surgical resection of select patients with recurrent gastric or gastroesophageal cancer can result in improved OS but often requires adjacent organ resection or interposition graft placement.