胃底贲门癌根治术中保留脾脏对预后的影响

Impact of spleen preservation on the outcome of radical resection for cardia cancer

目的探讨胃底贲门癌根治术中保留脾脏对预后的影响。方法回顾性分析1994年7月至2003年12月间108例经根治性手术治疗的胃底贲门癌患者的临床病理资料,比较保脾与切脾两组患者的并发症发生情况和预后。结果切脾组38例,保脾组70例,最后随访日期2004年12月。本组淋巴结转移率68.5%（74/108）,第10组淋巴结转移率16.7%。切脾组与保脾组术后并发症发生率（18.4%vs14%,χ^2=0.318,P=0.573）、肿瘤复发率和肿瘤病理特征差异均无统计学意义。保脾组5年生存率明显高于切脾组（38.7%vs16.9%,P=0.008）。多因素分析显示,保留脾脏不是影响预后的独立因素（P=0.085）,只有肿瘤浸润程度（P=0.009）和淋巴结转移（P=0.001）是独立的预后因素。结论除脾脏受侵犯者外,贲门癌根治术中应尽可能保留脾脏。

Objective To investigate the effect of spleen preservation on the outcome of radical resection for cardia cancer. Methods Data of 108 cardia cancer patients（Siewert types Ⅱ and Ⅲ）, undergone radical resection with D2 or D3 lymphadenectomy between July 1994 and December 2003 in our department, were analyzed retrospectively. Survival status was ascertained on December 2004. Of these 108 patients, 38 underwent splenectomy and 70 splenic preservation. Clinicopathological features and outcomes of the splenectomy and non-splenectomy groups were compared. Results Seventy-four patients （68.5%） had lymph node involvement; 18 patients （16.7%） had involvement of lymph nodes in the splenic hilus. Postoperative morbidity in two groups was similar. Overall 5-year survival rate in the non-splenectomy group was significantly higher than that of the splenectomy group （38.7% vs 16.9%, P=0.008）. Multivariate regression analysis indicated that tumor invasion （P=0.009） and lymph node metastasis （P=0.001） were independent prognostic factors rather than splenectomy. Although splenectomy was associated with survival, it was not an independent prognostic factor （P= 0.085）. Conclusions Splenectomy does not improve survival of patients undergone curative resection for gastric cardia cancer. Thus, the spleen should be preserved in patients without direct cancer invasion of the spleen.