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Surgical care quality and oncologic outcome after D2 gastrectomy for gastric cancer

World Journal of Gastroenterology 2015年第47期21卷 13294-13301页

作者： johanna mrena Anne Mattila Jan B?hm Ismo Jantunen Ilmo Kellokumpu Department of Surgery Central Hospital of Central Finland Department of Pathology Central Hospital of Central Finland Department of Oncology Central Hospital of Central Finland

AIM: To examine the quality of surgical care and longterm oncologic outcome after D2 gastrectomy for gastric ***: From 1999 to 2008, a total of 109 consecutive patients underwent D2 gastrectomy without routine pancreaticosplenectomy in a multimodal setting at our institution. Oncologic outcomes together with clinical and histopathologic data were analyzed in relation to the type of surgery performed. Staging was carried out according to the Union for International Cancer Control criteria of 2002. Patients were followedup for five years at the outpatient clinic. The primary measure of outcome was long-term survival with the quality of surgery as a secondary outcome measure. Clinical data were retrospectively collected from the patient records, and causes of death were obtained from national ***: A total of 109 patients(58 men) with a mean age of 67.4 ± 11.2 years underwent total gastrectomy or gastric resection with D2 lymph node dissection. The tumor stage distribution was as follows: stageⅠ,(27/109) 24.8%; stage Ⅱ,(31/109) 28.4%; stage Ⅲ,(41/109) 37.6%; and stage Ⅳ,(10/109) 9.2%. Forty patients(36.7%) received chemotherapy or chemoradiotherapy. The five-year overall survival rate for all 109 patients was 45.0%, and was 47.1% for the 104 patients treated with curative R0 resection. The five-year disease-specific survival rates were 53.0% and 55.8%, respectively. In a multivariate analysis, body mass index and tumor stage were independent prognostic factors for overall survival(both P < 0.01), whereas body mass index, tumor stage, tumor site, Lauren classification, and lymph node invasion were prognostic factors for cancer-specific survival(all P < 0.05). Postoperative 30-d mortality was 1.8% and 30-d, surgical(including three anastomotic leaks, two of which were treated conservatively), and general morbidities were 26.6%, 12.8%, and 14.7%, ***: D2 dissection is a safe surgical option for gastric cancer, providing quality

关键词： Gastric cancer Quality of care Survival Gastric surgery Clinical practice

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