Conversion surgery for gastric cancer: A cohort study from a western center
Conversion surgery for gastric cancer: A cohort study from a western center
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DOI：
10.1016/j.ijsu.2018.04.016
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发表时间：
2018-05-01
影响因子：
15.3
通讯作者：
Ercolani, Giorgio
中科院分区：
文献类型：
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作者：
Morgagni, Paolo;Solaini, Leonardo;Ercolani, Giorgio
背景：晚期不能切除的胃癌预后很差。本研究的目的是评估接受诱导化疗+/-胃切除术治疗进展期胃癌的患者的短期和长期结局。材料和方法：2005年4月至2016年8月期间，所有临床诊断为不可切除的局部晚期或IV期胃腺癌的患者均纳入本研究。结果：本组73例患者中，最佳支持治疗16例，单纯化疗35例，化疗加根治性手术22例。33例患者在化疗后接受了手术。22名患者接受了R 0手术，其余11名患者仅接受了探查手术。9例（40.9%）患者接受胃切除加腹腔热化疗。22例患者中有3例发生术后并发症，Clavien-Dindo分级高于2级。化疗加手术组的中位生存期为50个月，而单纯化疗组和最佳支持治疗组的中位生存期分别为14个月和3个月（p <0.0001）。对全组病例进行的考克斯回归分析表明，只有根治性中转手术是影响生存率的独立因素（HR 0.12，95%CI 0.05-0.29，p <0.0001）。结论：在能达到R0的情况下，中转胃切除术可延长生存期，是影响进展期胃癌患者预后的最重要因素。需要进一步的研究来确定真正能从这种治疗中受益的理想患者。
Background: Advanced unresectable gastric cancer has a dismal prognosis. The aim of this study was to evaluate the short-and long-term outcomes of patients who underwent induction chemotherapy +/- gastrectomy for advanced gastric cancer.Material and methods: All patients referred to our center with a clinical diagnosis of unresectable locally advanced or stage IV gastric adenocarcinoma between April 2005 and August 2016 were included in the study. Cox regression was performed to find independent prognostic factor among the considered variable.Results: The cohort included 73 patients: 16 had best supportive care, 35 chemotherapy alone and 22 chemotherapy plus radical surgery. Thirty-three patients underwent surgery after chemotherapy. Twenty-two patients had R0 surgery, while the remaining 11 had only an exploratory procedure. Nine patients (40.9%) underwent gastrectomy plus hyperthermic intraperitoneal chemotherapy. Three patients out of 22 developed postoperative complications with a Clavien-Dindo grade above 2. Median survival was 50 months for patients who had chemotherapy plus surgery while it was 14 and 3 for those who had chemotherapy alone and best supportive care, respectively (p < 0.0001). Cox regression analysis performed on the whole cohort identified only radical conversion surgery as an independent factor positively associated with survival (HR 0.12, 95% CI 0.05-0.29, p < 0.0001).Conclusion: Conversion gastrectomy, when R0 could be achieved, is associated with long survivals and it is the most important prognostic factor in patients with advanced gastric cancer. Further studies are needed to define the ideal patient who can really benefit from this treatment.