Concepts, Rationale, and Current Outcomes of Less Invasive Surgical Strategies for Early Gastric Cancer: Data from a quarter-century of experience in a single institution
Concepts, Rationale, and Current Outcomes of Less Invasive Surgical Strategies for Early Gastric Cancer: Data from a quarter-century of experience in a single institution
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早期胃癌微创手术策略的概念、原理和当前结果：来自单个机构四分之一世纪经验的数据
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发表时间：
2004
影响因子：
2.6
通讯作者：
M. Kaminishi
中科院分区：
文献类型：
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作者：
S. Shimoyama;Y. Seto;H. Yasuda;K. Mafune;M. Kaminishi
先前提出的早期胃癌微创手术标准主要基于切除标本的病理分析；然而，术前和术中信息对于患者分期管理的决策也很重要。此外，大多数适应症和治疗方案尚未系统地整合或评估治疗结果。我们在此报告中探讨微创手术用于EGC的合理性。对1976年至2000年间行根治性切除术的684例原发性孤立性EGC（379例粘膜癌，305例粘膜下癌）的阳性淋巴结分布进行了分析。强调和分析的临床病理因素包括临床（术前和术中）和病理（术后）肿瘤深度和淋巴结累及，大体形态，组织学类型，最大肿瘤直径，以及术后发病率和死亡率。对于临床粘膜、淋巴结阴性、不可触及的胃癌，或临床粘膜下、淋巴结阴性的肠型≤1.5 cm或弥漫性≤1.0 cm的胃癌，淋巴结切除范围可缩小到改良的D1。否则，改良D2淋巴结切除术就足够了。对于临床粘膜、淋巴结阴性且无明显溃疡≤4 cm的胃癌，如果相邻淋巴结经冰冻切片检查证实为癌阴性，可推荐局部切除。如果胃癌扩散超出上述标准，如果肿瘤位于胃中或胃下三分之一，只要肿瘤远端边缘距离幽门环至少4.5 cm，则可推荐行保幽门胃切除术（PPG）。根据各自的清扫标准，PPG可伴行改良D1或改良D2淋巴结切除术。结果显示，这些微创策略降低了发病率和死亡率，并且没有复发或癌症相关死亡。这些结果表明，我们对EGC微创手术的每一个标准都是现实的、分层的、令人满意的。
Previously proposed criteria of less invasive surgery for early gastric cancer (EGC) were based mainly on the pathological analyses of the resected specimens; however, preoperative and intraoperative information are also obviously essential for decision making on stage-dependent patient management. Furthermore, most indications and treatment options have not been systematically integrated or evaluated by treatment outcomes. We investigate in this report the rationality of less invasive surgery employed for EGC. Distribution analyses of positive nodes were investigated among 684 patients with primary solitary EGC (379 mucosal and 305 submucosal) who underwent curative resection between 1976 and 2000. Clinicopathological factors highlighted and analyzed included clinical (preoperative and intraoperative) and pathological (postoperative) cancer depth and nodal involvement, gross form, histological type, and maximum cancer diameter, as well as postoperative morbidity and mortality. The scope of lymphadenectomy can be reduced to a modified D1 for clinically mucosal, node-negative, nonpalpable gastric cancer, or for clinically submucosal, node-negative gastric cancer ≤ 1.5 cm for intestinal type, or ≤ 1.0 cm for diffuse type. Otherwise, a modified D2 lymphadenectomy is sufficient. Local resection can be recommended for clinically mucosal, node-negative gastric cancer without apparent ulceration ≤ 4 cm if adjacent lymph nodes are proved cancer negative by a frozen section examination. If the gastric cancer has spread beyond the above criteria, a pylorus-preserving gastrectomy (PPG) can be recommended for tumors located in the middle or lower third of the stomach, provided the distal margin of the cancer is at least 4.5 cm from the pyloric ring. The PPG can be accompanied by a modified D1 or a modified D2 lymphadenectomy according to the respective dissection criteria. Results of these less invasive strategies showed reduced morbidity and mortality, as well as no recurrence or cancer-related deaths. These results suggest that each of our criteria for less invasive surgery for EGC is realistic, well stratified, and satisfactory.
消化间期胃运动模式：迷走神经和非迷走神经外在神经支配的作用。
影响因子：
3.8
作者：
Spencer,MP;Sarr,MG;Hakim,NS;Soper,NJ
通讯作者：
Soper,NJ