Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion.
Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion.
复制标题
手术治疗pT4b胃癌胰头侵犯的回顾性分析
DOI：
10.12998/wjcc.v9.i29.8718
复制
发表时间：
2021-10-16
影响因子：
1.1
通讯作者：
Tian YT
中科院分区：
文献类型：
--
作者：
Jin P;Liu H;Ma FH;Ma S;Li Y;Xiong JP;Kang WZ;Hu HT;Tian YT
对于有胰头侵犯的进展期胃癌患者，一些研究表明扩大多器官切除(EMR)可以提高生存率。然而，其他报告显示EMR后的发病率和死亡率很高。T4b胃癌的EMR治疗仍然存在争议。目的探讨pT4b胃癌侵犯胰头的手术入路。2006年至2016年，中国国家癌症中心连续收治了144例侵犯胰头的胃癌患者。对76例经手术病理证实的胃癌患者进行了回顾性分析。通过比较两组患者的临床病理特征、手术效果和预后因素，将患者分为胃切除加全胃十二指肠切除组(GP组)和单纯胃切除组(GA组)。与GA组相比，GP组有24例(16.8%)患者的皮损明显增大(P<；0.001)，晚期N期的发生率较高(P=0.030)，新辅助化疗的发生率较低(P<；0.001)。GP组和GA组术后并发症发生率(33.3%比15.3%，P=0.128)和死亡率(4.2%比4.8%，P=1.000)差异无统计学意义。GP组总的3年生存率为47.6%，中位数为30.3mo，显著高于GA组的20.4%(中位数22.8mo，P=0.010)。多因素分析显示，新辅助化疗[危险比(HR)0.290，95%可信区间(CI)：0.103~0.821，P=0.020]、整形性鼻炎(HR 2.614，95%CI：1.024~6.675，P=0.033)、手术切缘(HR 0.274，95%CI：0.102~0.738，P=0.010)、N分期(HR 3.489，95%CI：1.334~9.120，P=0.011)、术后放化疗(HR 0.369，95%CI：0.163~0.836，P=0.017)可作为pT4b胃癌患者生存和胰头侵犯的独立预测因素。应对侵犯的胰腺进行根治性切除，以提高选定患者的存活率。侵犯胰头不是手术的禁忌症。
For advanced gastric cancer patients with pancreatic head invasion, some studies have suggested that extended multiorgan resections (EMR) improves survival. However, other reports have shown high rates of morbidity and mortality after EMR. EMR for T4b gastric cancer remains controversial. To evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion. A total of 144 consecutive patients with gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center. Gastric cancer was confirmed in 76 patients by postoperative pathology and retrospectively analyzed. The patients were divided into the gastrectomy plus en bloc pancreaticoduodenectomy group (GP group) and gastrectomy alone group (GA group) by comparing the clinicopathological features, surgical outcomes, and prognostic factors of these patients. There were 24 patients (16.8%) in the GP group who had significantly larger lesions (P < 0.001), a higher incidence of advanced N stage (P = 0.030), and less neoadjuvant chemotherapy (P < 0.001) than the GA group had. Postoperative morbidity (33.3% vs 15.3%, P = 0.128) and mortality (4.2% vs 4.8%, P = 1.000) were not significantly different in the GP and GA groups. The overall 3-year survival rate of the patients in the GP group was significantly longer than that in the GA group (47.6%, median 30.3 mo vs 20.4%, median 22.8 mo, P = 0.010). Multivariate analysis identified neoadjuvant chemotherapy [hazard ratio (HR) 0.290, 95% confidence interval (CI): 0.103–0.821, P = 0.020], linitis plastic (HR 2.614, 95% CI: 1.024–6.675, P = 0.033), surgical margin (HR 0.274, 95% CI: 0.102–0.738, P = 0.010), N stage (HR 3.489, 95% CI: 1.334–9.120, P = 0.011), and postoperative chemoradiotherapy (HR 0.369, 95% CI: 0.163–0.836, P = 0.017) as independent predictors of survival in patients with pT4b gastric cancer and pancreatic head invasion. Curative resection of the invaded pancreas should be performed to improve survival in selected patients. Invasion of the pancreatic head is not a contraindication for surgery.
登录
查看更多内容
影响因子：
2.6
作者：
Sakamoto，Yasuo;Sakaguchi，Yoshihisa;Okamura，Takeshi
通讯作者：
Okamura，Takeshi
影响因子：
3
作者：
Shchepotin, IB;Chorny, VA;Evans, SRT
通讯作者：
Evans, SRT
影响因子：
3.2
作者：
van der Werf, L. R.;Eshuis, W. J.;Tetteroo, G. W. M.
通讯作者：
Tetteroo, G. W. M.
影响因子：
168.9
作者：
Bang, Yung-Jue;Kim, Young-Woo;Noh, Sung Hoon
通讯作者：
Noh, Sung Hoon
影响因子：
45.3
作者：
Sasako, Mitsuru;Sakuramoto, Shinichi;Ohashi, Yasuo
通讯作者：
Ohashi, Yasuo