新辅助化疗联合腹腔镜辅助D2近端胃癌根治术治疗近端进展期胃癌

Neoadjuvant Chemotherapy Combined with Laparoscopy-assisted Surgery for Advanced Proximal Gastric Cancer: a Clinical Research of 36 Cases

目的 评价新辅助化疗联合腹腔镜治疗近端进展期胃癌的临床疗效.方法 回顾性分析2009年2月~2013年2月36例近端局部进展期胃癌的临床资料.行2周期改良FOLFOX方案化疗,根据影像学资料观察病灶变化,有效者30例再化疗2周期.均于化疗结束后3周接受腹腔镜辅助D2近端胃癌根治术.结果 新辅助化疗后原发病灶获完全缓解5例（13.9%）,部分缓解17例（47.2%）,疾病稳定8例（22.2%）,疾病进展6例（16.7%）;总有效率为61.1%（22/36）.手术均获成功,手术时间（275±50）min,术中出血量（130±40）ml,淋巴结清扫数目（23.3±7.6）枚;术后胃肠道功能恢复时间（3.7±1.8）d.术后肺部感染2例,术后5天误吸死亡1例.随访4~48个月,平均23.8月,复发率8.6%（3/35）,病死率5.7%（2/35）.结论 新辅助化疗联合腹腔镜治疗近端局部进展期胃癌安全有效,术前肿瘤降期明显,同时具有创伤小、术后恢复快等优点,但远期疗效尚需大样本长期观察.

Objective To evaluate the treatment effect of neoadjuvant chemotherapy combined with laparoscopic surgery on advanced proximal gastric cancer. Methods We retrospectively analyzed the clinical data of 36 patients with advanced proximal gastric cancer undergoing 2 courses of chemotherapy with FOLFOX regimen in our hospital from February 2009 to February 2013. Based on iconographic results, 30 cases showed effective results through gastroscopy and CT, and they received another two courses of chemotherapy. Radical gastrectomy was performed for all patients three weeks after chemotherapy. Results The total effective rate of neoadjuvant chemotherapy was 61.1% （22/36）. Clinical complete response （CR） occurred in 5 cases （ 13.9% ） , partial response （PR） in 17 cases （47.2%）, stable symptoms （SD） in 8 cases （22.2%） , and disease progressive （PD） in 6 cases（ 16.7% ）. All surgeries were successfully performed. The operative time was （275 ± 50） min, the intraoperative blood loss was （130 ± 40） ml and the number of lymph node dissected was （23.3 ± 7.6）. Postoperative gastrointestinal function recovery time was （ 3.7 ± 1.8 ） d. Two patients suffered postoperative lung infection, and 1 died due to aspiration 5 days after the surgery. Patients were followed up for 4 - 48 months （average, 23.8 months）. The recurrence rate was 8.6% （3/35） and the mortality rate was 5.7% （2/35）. Conclusions The neoadjuvant chemotherapy combined with laparoscopic surgery for advanced proximal gastric cancer is safe and effective, especially in the early-stage tumor. It has the advantages of minimal invasion and rapid recovery. A large sample is still needed for the long-term effect of the procedure.