Subtotal versus total gastrectomy for gastric cancer -: Five-year survival rates in a multicenter randomized Italian trial
Subtotal versus total gastrectomy for gastric cancer -: Five-year survival rates in a multicenter randomized Italian trial
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DOI：
10.1097/00000658-199908000-00006
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发表时间：
1999-08-01
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
目的评价胃大部切除术（SG）与全胃切除术（TG）对来自28家意大利机构的远端胃癌患者的肿瘤学结局的影响。方法本分析涉及618例手术期间随机分配的患者，SG（315）或TG（303），前提是肿瘤近端边缘至贲门至少6 cm，无腹膜内或远端扩散，并且有可能完全切除肿瘤。两种手术治疗包括区域淋巴结清扫术。结果四例患者死亡后SG和TG后7。中位随访时间为SG后72个月（范围2 - 125）和TG后75个月（范围7 - 113）。采用Kaplan-Meier法计算的5年生存率分别为65.3%和62.4%。等效性检验得出的结论是，就5年生存概率而言，两种手术可视为等效。使用多变量考克斯回归模型进行的生存分析显示，肿瘤部位对生存的影响具有统计学意义。肿瘤在胃壁内的扩散，脾脏切除的范围加上或减去邻近器官或结构，以及切除淋巴结转移的相对频率。作者认为，如果切除的近端边缘福尔斯落在健康组织中，则SG（已报告与更好的营养状态和生活质量相关）应作为首选手术。
ObjectiveTo evaluate the impact of subtotal (SG) versus total (TG) gastrectomy on the oncologic outcome of patients with cancer of the distal stomach from 28 Italian institutions.Summary Background DataThere is controversy over whether SG and TG have a different impact on the 5-year survival probability of patients with cancer of the distal half of the stomach.MethodsThe present analysis involved 618 patients randomized during surgery to SG (315) or TG (303), provided there was at least 6 cm from the proximal edge of the tumor to the cardia, there was no intraperitoneal or distant spread, and it was possible to remove the tumor entirely. Both surgical treatments included regional lymphadenectomy.ResultsFour patients died after SG and seven after TG. Median follow-up was 72 months after SG (range 2 to 125) and 75 months after TG (range 7 to 113). Five-year survival probability as computed by the Kaplan-Meier method was 65.3% for SG and 62.4% for TG. The test of equivalence led to the conclusion that the two procedures may be considered equivalent in terms of 5-year survival probability. The analysis of survival using a multivariate Cox regression model showed a statistically significant impact on survival of tumor site. tumor spread within the gastric wall, extent of resection to the spleen plus or minus neighboring organs or structure, and relative frequency of metastasis in resected lymph nodes.ConclusionsBoth procedures have a similar survival probability. The authors believe that SG, which has been reported to be associated with a better nutritional status and quality of life, should be the procedure of choice, provided that the proximal margin of the resection falls in healthy tissue.