SURGICAL TREATMENT OF ADVANCED GASTRIC CANCER

N. Ignjatovic, G. Stanojevic, M. Stojanović, L. Jeremić, M. Nestorović, Vesna Brzački, D. Stojanov, M. Djordjevic, M. Marinkovic
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Abstract

Patients with advanced gastric cancer generally have poor overall prognosis as well as survival rate. Unfortunately, in the West, gastric cancer typically occurs at an advanced stage and many of these patients have tumor invasion into adjacent structures (International Union Against Cancer [UICC]/American Joint Committee on Cancer [AJCC] Stage T4). Although T4 gastric cancer patients often have peritoneal dissemination or distant metastasis, many do not have M1 disease and are therefore candidates for surgery with the curative intent. A multivisceral resection (MVR) or gastrectomy with resection of adjacent organs is needed in T4 gastric cancer patients to achieve an R0 resection that is one of the most powerful forecasters of gastric cancer surgery results. Spleen, distal pancreas, liver, and large intestine (mostly transverse colon) were the most commonly resected organs. The therapeutic choice with acceptable postoperative morbidity and mortality rates in locally advanced patients with gastric cancer should be gastrectomy with MVR, where complete resection could be realistically obtained and where metastatic involvement of the lymph node is not evident. MVR is done with a curative R0 resection to provide advanced gastric cancer patients with the best survival chance. It was found that resections involving the pancreas, transverse colon and liver were associated with increased survival rate in comparison to MVR with resection of other structures. It was shown that survival rate significantly decreased in patients who had undergone MVR without complete resection compared to those who had an R0 resection. Nevertheless, the extent of the surgical resection required and further advantages of MVR are disputable.
晚期胃癌的外科治疗
晚期胃癌患者总体预后差,生存率低。不幸的是,在西方,胃癌通常发生在晚期,许多患者的肿瘤侵入邻近结构(国际抗癌联盟[UICC]/美国癌症联合委员会[AJCC] T4期)。虽然T4胃癌患者经常有腹膜播散或远处转移,但许多患者没有M1疾病,因此具有治疗目的的手术候选人。T4期胃癌患者需要多脏器切除(MVR)或胃切除术并切除邻近器官,以实现R0切除,这是胃癌手术结果最有力的预测因素之一。脾脏、胰腺远端、肝脏和大肠(主要是横结肠)是最常被切除的器官。局部晚期胃癌患者术后发病率和死亡率可接受的治疗选择应该是MVR胃切除术,在这种情况下可以获得完全切除,并且淋巴结转移累及不明显。MVR与根治性R0切除术一起进行,为晚期胃癌患者提供了最佳的生存机会。研究发现,切除胰腺、横结肠和肝脏与切除其他结构的MVR相比,生存率更高。研究表明,与R0切除的患者相比,未完全切除的MVR患者的生存率显著降低。然而,手术切除的范围和MVR的进一步优势是有争议的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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