脾切除并中上部胃癌根治性全胃切除术对患者生存的影响

Effect of splenectomy combined with radical total gastrectomy on the survival of patients with proximal gastric carcinoma

目的 研究中上部胃癌根治性全胃切除术同时行脾切除或不切除对患者生存的影响。方法 回顾性分析 7年间 7 9例中上部胃癌行根治性全胃切除术患者的临床病理资料。 7 9例中, 1 7例( 2 1. 5% )行脾切除 (切脾组 ), 6 2例 ( 7 8. 5% )不行脾切除术 (保脾组 )。两组患者在年龄、性别、肿瘤大小、肿瘤位置、Borrmann分型、组织学类型、组织分化程度、浸润深度、TNM分期、切除的淋巴结数目、淋巴结转移率、术后并发症发生率、复发率等方面差异无显著性 (P > 0. 0 5 )。结果 切脾组中位生存期为 ( 5 0 7. 5±3 1 8. 6 )d,而保脾组为 ( 8 4 9. 4±6 7 2. 9 )d,两组间差异有显著性 (P= 0. 046 )。切脾组患者 1, 3, 5年生存率分别为 6 1. 1 8% , 8. 2 3%和 0 % ,而保脾组分别为 8 1. 5 6 % , 4 8. 2 8 %和 3 0. 6 2 %。多因素Cox回归分析显示,保脾或切脾是惟一影响患者预后的危险因素 (P = 0. 007 )。结论 切脾与否对术后并发症和复发率无明显影响。脾切除术不能延长中上部胃癌根治性全胃切除患者的术后生存时间和提高其生存率,保脾手术则可延长患者的术后生存时间和提高其生存率。脾切除术可能仅适用于胃癌直接侵犯脾脏者。

Objective To investigate the effect of simultaneous splenectomy or non-removal of spleen on the survival of patients undergoing radical total gastrectomy for carcinoma of the middle and proximal stomach. Methods The clinical data of 79 patients with proximal gastric cancer (located in proximal or middle (stomach)) who (underwent) radical total gastrectomy between 1994 and 2001 were investigated retrospectively. Of these 79 (patients),17 patients (21.5%) underwent splenectomy and 62 patients (78.5%) did not. There were no significant differences in ages,sex,tumor size,tumor location,Borrmann type,histolgic type,histological differentiation, depth of invasion, lymph node metastasis,TNM staging, the number of (resected) lymph nodes,rate of lymph node metastasis, postoperative complications and recurrence rate between the two groups(P>0.05). Results The median survival of patients with splenectomy and without (splenectomy) was (507.4±318.6) days and (849.4±672.9) days,respectively.The patients without splenectomy survived (significantly) longer than those with splenectomy(P=0.046).The 1-year,3-year and 5-year survival rates of patients with splenectomy and without splenectomy were 61.18%, 8.23%, (0%) and (81.56%), 48.28%, 30.62%, respectively. Multivariate Cox regression analysis indicated that (only ) (splenectomy) was an independent prognostic factor (P=0.007). Conclusions The rates of postoperative complications and tumors recurrence were not influenced by splenectomy. Splenectomy did not prolong the survival time of patients with proximal gastric carcinoma who underwent radical total gastrectomy. Preservation of the spleen can prolong postoperative survival time and improve the survival rate in these patients.Splenectomy might only be (appropriate) for patients with direct invasion of the spleen.