|
|
|
题名
|
作者
|
年代
|
出处
|
被引量
|
| 1 | Gastric cancer: Current status of lymph node dissection显示文摘D2 procedure has been accepted in Far East as the standard treatment for both early(EGC) and advanced gastric cancer(AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials(RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council(MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recur-rence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC. | Maurizio Degiuli Giovanni De Manzoni Alberto Di Leo Domenico D'Ugo Erica Galasso Daniele Marrelli Roberto Petrioli Karol Polom Franco Roviello Francesco Santullo Mario Morino | 2016 | World Journal of Gastroenterology2016，22，10： | 29 |
| 2 | 淋巴结转移阴性的低分化和未分化胃腺癌的预后因素分析显示文摘目的 探讨影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的相关因素.方法 回顾性分析2002年1月至2007年12月天津医科大学附属肿瘤医院收治的270例淋巴结转移阴性的低分化和未分化胃腺癌患者的临床病理资料.患者均行胃癌根治术,其中术中淋巴结清扫数目<15枚的患者161例、15~20枚患者53例、21 ~30枚患者33例、>30枚患者23例.采用门诊、电话、信件等方式进行随访.随访时间截至2013年10月.采用COX模型逐步后退法进行预后因素分析.采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 270例患者术后均获得随访,随访率为100.00%(270/270),中位随访时间为63个月(2~103个月).患者总体中位生存时间为63个月(2~103个月),1、3、5年总体生存率分别为93.0% 、69.5% 、58.5%.其中161例淋巴结清扫数目<15枚患者中位生存时间为58个月(2~103个月),1、3、5年生存率分别为91.4%、59.3%、48.8%;53例淋巴结清扫数目15 ~ 20枚患者中位生存时间为68个月(4 ~95个月),1、3、5年生存率分别为94.3%、84.9%、71.7%;33例淋巴结清扫数目21~ 30枚患者中位生存时间为68个月(34 ~ 94个月),1、3、5年生存率分别为100.0%、97.0%、87.9%;23例淋巴结清扫数目>30枚患者中位生存时间为60个月(2~84个月),1、3、5年生存率分别为87.5%、62.5%、54.2%.不同淋巴结清扫数目患者预后比较,差异有统计学意义(x2=25.077,P<0.05).淋巴结清扫数目21 ~30枚患者预后优于15 ~20枚患者,差异有统计学意义(x2=3.924,P<0.05);淋巴结清扫数目15 ~ 20枚患者预后优于>30枚患者,差异有统计学意义(x2=4.454,P<0.05);淋巴结清扫数日>30枚患者与<15枚患者预后比较,差异无统计学意义(x2=0.450,P>0.05).单因素分析结果显示:患者性别、年龄、肿瘤部位、肿瘤直径、浆膜浸润、Borrmann分型、胃切除范围和淋巴结清扫数目是影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的相关因素(x2=4.143,12.607,23.665,11.549,26.350,8.059,5.222,25.077,P<0.05).多因素分析结果显示:肿瘤直径>5 cm、浆膜浸润是影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的独立危险因素(HR=1.842,3.084,95%可信区间:1.286~2.638,1.956~4.861,P <0.05);淋巴结清扫数目21 ~30枚是其预后的保护因素(HR=1.533,95%可信区间:1.229~2.248,P<0.05).结论 行胃癌根治术时淋巴结清扫数目为21~ 30枚,可改善患者预后.肿瘤直径>5 cm、浆膜浸润和淋巴结清扫数目<15枚、15 ~ 20枚及>30枚是影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的独立危险因素. | 蒋楠 邓靖宇 刘勇 刘宏根 梁寒 | 2014 | 中华消化外科杂志2014，13，8： | 9 |
| 3 | Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer显示文摘Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy(D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy(D1). United States and Northern Europe are considered the scientific leaders in medicine and evidencebased procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan(107898 in 2012) than in the entire European Union(81592), or in South Korea(31269) than in the entire United States(21155). For quite a long time evidence-based medicine(EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature(2008-2012) and surgical guidelines. We searched PubMed for papers using the key words 'lymphadenectomy or D1 or D2' AND 'gastric cancer' from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts' opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard of care for advanced gastric cancer by Japanese National Guidelines since 1981 and was adopted as the standard procedure by the Italian Research Group for Gastric Cancer since the Nineties. D2 is now indicated as the standard of surgical treatment with curative intent by the German, British and ESMO-ESSO-ESTRO guidelines. At variance American NCCN guidelines recommend a D1+ or a modified D2 lymph node dissection. In conclusion, D2 lymphadenectomy, originally developed by Eastern surgeons, is now becoming the procedure of choice also in the West. In gastric cancer surgery EBM is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures. | Giuseppe Verlato Simone Giacopuzzi Maria Bencivenga Paolo Morgagni Giovanni De Manzoni | 2014 | World Journal of Gastroenterology2014，20，36： | 8 |
您所在的机构暂未开通此部分的功能，请联系管理员