胃腸吻合術聯合術后化療治療不能根治切除伴幽門梗阻的進展期胃癌_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

張震 ^1,2 , 蘇妍卓 ¹ , 李暢 ¹ ,  孫立波 ¹

1. ;
2. ;

Corresponding?author：

孫立波, Email: sunlibo0431@sina.com

Keywords：

進展期胃癌; 姑息治療; 胃腸吻合; 化療; 預后

DOI：

10.7507/1007-9424.201905117

Video：

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目的探討不能根治性切除伴幽門梗阻進展期胃癌行胃腸吻合結合術后化療的效果。方法選擇 37 例符合納入及排除標準的病例，進行回顧性研究，分析手術相關數據，化療效果和生存情況。結果手術后 4 周復查胃出口梗阻評分系統（GOOSS）的評分、體質量指數（BMI）、血紅蛋白及白蛋白指標，除 BMI 外，其他 3 項指標均明顯好轉，與術前比較差異具有統計學意義（P<0.001，P=0.027，P=0.08）。化療后腫瘤病灶縮小 23 例（62.2%），無明顯變化 11 例（29.7%），腫瘤較前增大 3 例（8.1%）。化療后轉移淋巴結縮小或消失 17 例（68.0%），6 例（24.0%）無明顯變化，2 例（8.0%）淋巴結較前增大。化療前有腹水 20 例（54.1%），化療后腹水減少甚至消失 17 例（85.0%），腹水無明顯變化 3 例（15.0%），無腹水增多者。本組 37 例患者中獲隨訪 35 例，隨訪率為 94.6 %；隨訪時間 6～30 個月，平均 17.8 個月；本組患者的生存時間 6～30 個月，中位生存時間 11.6 個月。結論對于不能根治性切除的合并幽門梗阻的進展期胃癌，胃腸吻合術后聯合化療可獲得較滿意的治療效果。

Citation： 張震, 蘇妍卓, 李暢, 孫立波. 胃腸吻合術聯合術后化療治療不能根治切除伴幽門梗阻的進展期胃癌. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(11): 1342-1345. doi: 10.7507/1007-9424.201905117 Copy

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16.	Martin-Romano P, Solans BP, Cano D, et al. Neoadjuvant therapy for locally advanced gastric cancer patients. A population pharmacodynamic modeling. PLoS One, 2019, 14(5): e0215970.
17.	Sun LB, Zhao GJ, Ding DY, et al. Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective, comparative study at a single tertiary care institute. World J Surg Oncol, 2014, 12: 280.
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19.	Ryo S, Kanda M, Ito S, et al. The controlling nutritional status score serves as a predictor of short- and long-term outcomes for patients with stage 2 or 3 gastric cancer: analysis of a multi-institutional data set. Ann Surg Oncol, 2019, 26(2): 456-464.
20.	Nelen SD, van Putten M, Lemmens VEPP, et al. Effect of age on rates of palliative surgery and chemotherapy use in patients with locally advanced or metastatic gastric cancer. Br J Surg, 2017, 104(13): 1837-1846.
21.	Larssen L, Hauge T, Medhus AW. Stent treatment of malignant gastric outlet obstruction: the effect on rate of gastric emptying, symptoms, and survival. Surg Endosc, 2012, 26(10): 2955-2960.
22.	Kano M, Hayano K, Hayashi H, et al. Survival benefit of neoadjuvant chemotherapy with S-1 plus docetaxel for locally advanced gastric cancer: a propensity score-matched analysis. Ann Surg Oncol, 2019, 26(6): 1805-1813.
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1. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol, 2006, 12(3): 354-362.
2. Ye S, Wang L, Zuo Z, et al. The role of surgery and radiation in advanced gastric cancer: A population-based study of Surveillance, Epidemiology, and End Results database. PLoS One, 2019, 14(3): e0213596.
3. Fujitani K, Ando M, Sakamaki K, et al. Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer. BJS Open, 2018, 1(6): 165-174.
4. Hu M, Zhang S, Yang X, et al. The prognostic value of lymph node ratio for local advanced gastric cancer patients with adjuvant chemoradiotherapy after D2 gastrectomy. Medicine (Baltimore), 2018, 97(44): e13079.
5. 魏波, 衛洪波. 進展期胃癌的治療策略. 中華胃腸外科雜志, 2018, 21(10): 1099-1102.
6. Degiuli M, De Manzoni G, Di Leo A, et al. Gastric cancer: Current status of lymph node dissection. World J Gastroenterol, 2016, 22(10): 2875-2893.
7. Morita S, Fukagawa T, Fujiwara H, et al. The clinical significance of para-aortic nodal dissection for advanced gastric cancer. Eur J Sur Oncol, 2016, 42(9): 1448-1454.
8. 孫元水, 許曉東, 胡俊峰, 等. 新輔助化療聯合營養支持在幽門梗阻患者的應用. 中華醫學雜志, 2014, 94(8): 584-586.
9. 鄧國鵬, 曲建軍, 翟升永, 等. 新輔助化療對局部進展期胃癌營養狀況影響的臨床研究. 中華胃腸外科雜志, 2018, 21(3): 331-335.
10. Mazumdar M, Smith A, Schwartz LH. A statistical simulation study finds discordance between WHO criteria and RECIST guideline. J Clin Epidemiol, 2004, 57(4): 358-365.
11. Bulut E, ?ift?i T, Akhan O, et al. Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches. Diagn Interv Radiol, 2017, 23(3): 211-216.
12. Potz BA, Miner TJ. Surgical palliation of gastric outlet obstruction in advanced malignancy. World J Gastrointest Surg, 2016, 8(8): 545-555.
13. Miner TJ, Jaques DP, Karpeh MS, et al. Defining palliative surgery in patients receiving noncurative resections for gastric cancer. J Am Coll Surg, 2004, 198(6): 1013-1021.
14. Brimhall B, Adler DG. Enteral stents for malignant gastric outlet obstruction. Gastrointest Endosc Clin N Am, 2011, 21(3): 389-403.
15. Xiao C, Qian J, Zheng Y, et al. A phase Ⅱ study of biweekly oxaliplatin plus S-1 combination chemotherapy as a first-line treatment for patients with metastatic or advanced gastric cancer in China. Medicine (Baltimore), 2019, 98(20): e15696.
16. Martin-Romano P, Solans BP, Cano D, et al. Neoadjuvant therapy for locally advanced gastric cancer patients. A population pharmacodynamic modeling. PLoS One, 2019, 14(5): e0215970.
17. Sun LB, Zhao GJ, Ding DY, et al. Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective, comparative study at a single tertiary care institute. World J Surg Oncol, 2014, 12: 280.
18. Kosaka T, Akiyama H, Miyamoto H, et al. Outcomes of preoperative S-1 and docetaxel combination chemotherapy in patients with locally advanced gastric cancer. Cancer Chemother Pharmacol, 2019, 83(6): 1047-1055.
19. Ryo S, Kanda M, Ito S, et al. The controlling nutritional status score serves as a predictor of short- and long-term outcomes for patients with stage 2 or 3 gastric cancer: analysis of a multi-institutional data set. Ann Surg Oncol, 2019, 26(2): 456-464.
20. Nelen SD, van Putten M, Lemmens VEPP, et al. Effect of age on rates of palliative surgery and chemotherapy use in patients with locally advanced or metastatic gastric cancer. Br J Surg, 2017, 104(13): 1837-1846.
21. Larssen L, Hauge T, Medhus AW. Stent treatment of malignant gastric outlet obstruction: the effect on rate of gastric emptying, symptoms, and survival. Surg Endosc, 2012, 26(10): 2955-2960.
22. Kano M, Hayano K, Hayashi H, et al. Survival benefit of neoadjuvant chemotherapy with S-1 plus docetaxel for locally advanced gastric cancer: a propensity score-matched analysis. Ann Surg Oncol, 2019, 26(6): 1805-1813.
23. Hosoda K, Watanabe M, Yamashita K. Re-emerging role of macroscopic appearance in treatment strategy for gastric cancer. Ann Gastroenterol Surg, 2018, 3(2): 122-129.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

胃腸吻合術聯合術后化療治療不能根治切除伴幽門梗阻的進展期胃癌

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