ISSN:0253-4886    

DOI:10.1159/000172221

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172222

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172223

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Gastric cancer mortality continues to fall worldwide. The decline in incidence is less rapid suggesting that either operative mortality or surgical treatment is improving or both. A review of English language literature has confirmed a progressive and significant decline in operative mortality between 1970 and 1990. Similarly, in reported series in the English language literature, the 5-year survival rates following resections for gastric cancer have significantly increased between 1970 and 1990. Between these years, the outlook for patients with gastric cancer has improved and that improvement continues. There should be uniformity in recording and reporting of series. Clinicians treating gastric cancer should continue to pursue early diagnosis and more radical surgical treatment.

ISSN:0253-4886    

DOI:10.1159/000172224

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A multicentric randomized trial conducted by the French Associations for Surgical Research tested total gastrectomy (TG) versus subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated with curative intent, in terms of postoperative mortality and 5-year survival. TG was performed in 76 patients and 93 patients underwent SG. Elective TG did not increase postoperative mortality (1.3%) compared with SG (3.2%). There was no statistical difference between the two techniques with regard to 5-year survival (48%). These results were reviewed according to the most recent controversies reported in the literature, i.e. the radicality in lymph node resection enabled by each of the two procedures, the required proximal free margins in SG, the long-term risk of a gastric stump and the nutritional consequences of each technique.

ISSN:0253-4886    

DOI:10.1159/000172225

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

This report describes an original laparoscopic treatment for early gastric cancer with curative intent. After laparoscopic exposure of the gastric wall around a cancerous lesion, a small metal rod is introduced into the stomach at the vicinity of the lesion through a catheter which pierces the abdominal wall and the exposed gastric wall. While the cancerous lesion is lifted up precisely with the support of the metal rod, wedge resection of the stomach is carried out using an endoscopic stapling device. This procedure results in complete local resection of the lesion with a sufficient surgical margin. We have applied this method to 6 patients with mucosal gastric cancer. Postoperative courses were all uneventful, and the histology revealed they were curative resections. Provided the indication is selected properly, it could be a curative and minimally invasive treatment for early gastric cancer.

ISSN:0253-4886    

DOI:10.1159/000172226

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The aim of this study was to evaluate the influence of lymph node involvement (LNI) as an independent factor on survival of patients who underwent a resection with curative intent. Out of 156 patients operated on, 86 had a resection with curative intent. Multivariate analysis (Cox model) selected LNI as the only independent factor by stepwise analysis. The overall 5-year survival in patients without LNI was 75 ± 8%, with proximal LNI 28 ± 10% and with distal LNI 7 ± 6%. Although the number of patients included in this study was small, its results were validated on sets of patients from other series. We can therefore recommend these three stages of LNI as a reliable prognostic index in patients with gastric carcinoma undergoing a resection with curative inte

ISSN:0253-4886    

DOI:10.1159/000172227

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Despite encouraging results from Japan, the role of systematic lymphadenectomy in the surgical treatment of gastric carcinoma remains controversial in the Western hemisphere. We have performed systematic lymphadenectomy since 1978. In a prospective study of 397 patients with primary gastric carcinoma (1986-1993), we resected a mean of 32 lymph nodes (total: n = 12,703), and 26.9% of them (n = 3,421) showed lymph node metastases. Postoperative morbidity and mortality were 28.7 and 5.3%, respectively. Survival analysis identified patients with a maximum of three metastatic nodes to have a prognosis similar to those without lymph node involvement. Additionally, the prognosis could be improved in stage II and Ilia. These data argue for a routine systematic lymphadenectomy for treatment of gastric carcinoma with curative intent, since it bears substantial diagnostic (i.e. staging) and therapeutic (i.e. improved prognosis in subgroups of patients) relevance.

ISSN:0253-4886    

DOI:10.1159/000172228

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Complications of extended gastric surgery and their prevention were discussed. To determine the incidence of postoperative complications, 1,114 gastric cancer patients with radical lymph node dissection (D2 or more) were examined. The postoperative complication rate following total gastrectomy (30.9%) was significantly higher than that following distal gastrectomy (14.6%). In total gastrectomy cases, the rate of postoperative complications in D4 dissection cases (50.0%) was significantly higher than in D2 (29.8%) and D3 (22.4%) dissection cases. Moreover, the more extensive the combined resection, the greater the incidence of postoperative complications, anastomotic insufficiency and operative mortality. Concerning the complications accompanying lymph node dissection, hepatic dysfunction due to damage of the proper hepatic artery (2 cases), bile leakage (7 cases) and jaundice (1 case) due to damage to the biliary tract were seen. Ascites due to lymphorrhea following extended lymphadenectomy was recognized in 9 cases. The greatest cause of death was major leakage, the second was septicemia, the third was pneumonia and the fourth was intra-abdominal bleeding. For the prevention of these complications, in addition to meticulous attention to the pre-/postoperative management, careful operative manipulation to avoid damage to main abdominal blood vessels, lymph leakage, anastomotic leakage and pancreatic fistula is necessary.

ISSN:0253-4886    

DOI:10.1159/000172229

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Between August 1989 and July 1993, a controlled randomized trial was performed in the Netherlands to compare the therapeutic efficacy of Dl resection with limited (N1 level) lymphadenectomy versus D2 resection with extended lymph node dissection (N1 and N2 level). In this trial, a total of 1,078 patients were randomized, of whom 996 (92%) were eligible for analysis. Of these, 711 (71 %) were operated on with curative intent and 285 (29%) underwent a non-curative procedure. The actual distinction between limited and extended lymphadenectomy was analyzed. Nonadherence to the protocol was evaluated on the basis of noncompliance (no yield of lymph nodes from indicated stations) and contamination (finding of one or more lymph nodes for which dissection was not indicated). In the first period, data of 237 patients (115 D1 and 122 D2) operated on with curative intent were available. Noncompliance occurred in 84% of both Dl and D2 resections, while contamination was seen in 48% of D1 and 52% of D2 resections. Contamination and noncompliance indicate a partial loss of distinction between the two types of resection, showing the tendency of performing an intermediate type of resection, D1.5. Additional measures were taken, such as stricter perioperative quality control, centralized lymph node retrieval and evaluation of protocol deviations per participating team to improve standardization of the surgicopathological team performance. After implementing these measures, in the second period, noncompliance did not decrease significantly; 236 (138 Dl and 98 D2) patients (p = 0.08), while in D2 the decrease was significant (p = 0.03). The contamination rate decreased significantly in both Dl (p < 0.05) and D2 (p = 0.02) resections. Furthermore, our results proved that extended lymphadenectomy induced a substantial stage migration. In conclusion, the implementation of measures improved standardization of the surgicopathological team performance. Stage migration is also demonstrated in our randomized controlled trial. Not only major changes in clinical practice, such as routine application of extended lymphadenectomy, but also more subtle changes in the performance of the surgicopathological team, such as contamination, noncompliance and diligence, strongly affect stage-specific survival rates.

ISSN:0253-4886    

DOI:10.1159/000172230

出版商:S. Karger AG    

年代:1994

数据来源: Karger