胃底贲门癌侵及胰体尾外科治疗的预后分析

Prognosis analysis of surgical treatment for cancer of stomach fundus and cardia with invasion to body and tail of the pancreas

目的探讨影响胃底贲门癌侵及胰体尾外科治疗预后的因素。方法对135例胃底贲门癌侵及胰体尾患者进行手术，其中剖腹探查术20例，联合脾及胰体尾切除术115例。对影响手术的预后进行单因素及多因素分析，并分析术后的并发症发生率和病死率。结果剖腹探查术和联合脾及胰体尾切除术患者的中位生存期分别为4．7个月和30．5个月，差异有统计学意义（X^2=403．8，P〈0．01）。联合脾及胰体尾切除术患者的3、5年生存率分别为48．3％、26．6％；肿瘤的直径、大体分型、浸润深度、淋巴结转移、No．10或No．11淋巴结转移、根治程度和受侵脏器切除数目为影响预后的相关因素；其中浸润深度、淋巴结转移分期、手术根治程度及受侵脏器切除数目为影响预后的独立因素。术后并发症发生率和病死率分别为20．0％和3．5％。结论对于胃底贲门癌侵及胰体尾患者，施行联合脾及胰体尾切除术能够提高疗效。如果患者无淋巴结转移、或无不可根治因素存在、或无合并其他脏器受侵，施行联合脾及胰体尾切除术疗效最好。

Objective To investigate the prognostic factors of surgical treatment for the cancer of stomach fundus and cardia with invasion to body and tail of the pancrea. Methods A total of 135 patients with cancer of stomach fundus and cardia invading body and tail of the pancrea undergone surgical treatment were enrolled in this study. Twenty of them underwent laparotomy, while 115 underwent gastrectomy with pancrcaticosplenectomy, even combined with the resection of other organs for macroscopic invasion to adjacent organs during surgery. The 3-,5-year survival rates, morbility of postoperative complications and mortality were followed up. The prognostic factors were evaluated by univariate and multivariate analyses. Results The median survival time of the patients undergone laparotomy was 4.7 months, of patients treated by gastrectomy combined with pancreaticos- plenectomy was 30.5 months,and the difference was significant （X^2=403.8, P〈0.01）. The cumulative 3- and 5-year survival rates of the patients treated by gastrectomy combined with pancreaticosplenectomy were 48.3% and 26.6% respectively. Univariate analysis revealed that significant differences in prognosis of 115 patients undergone combined resection were demonstrated for the following factors： maximal dimension of tumor, macroscopic type, extent of lymph node metastasis according to the Japanese classification, No.10 or No. 11 lymph node metastasis,curability and number of invaded organs.And histological depth of invasion, extent of lymph node metastasis according to the Japanese classification, number of invaded organs and curability were significant prognostic factors, examined as variables by multivariate analysis （Cox＇s proportional hazard model, forward stepwise selection LR method）. The postoperative complication rate and mortality of 135 patients were 20.0% and 3.5% respectively.Conclusions For cancer located in stomach fundus and cardia with limited invasion to distal pancreas, gastreetomy combined with pancreaticosplenectomy should be performed to improve long-term outcomes. Best long-term survival outcomes would be attained if there are no lymph node metastases, or no incurable factors, or no other organ invasions.