老年胃癌患者外科治疗的临床研究

目的探讨老年胃癌患者的临床特点及其外科治疗方法的选择及预后。方法回顾性分析1993年1月至2003年1月收治的443例≥65岁老年人胃癌的临床资料和生存资料。结果本组围手术期病死率为2.5%,手术并发症发生率为20.1%。根治性胃切除组术后1、3、5年生存率分别为90%、65.8%和42.1%,姑息性胃切除组分别为73.6%、13.6%和0,未切除组平均生存10月。各组术后生存率比较差异有统计学意义(P<0.05)。结论老年人胃癌术后并发症较多,围手术期处理至关重要。手术方式应视患者全身情况、癌肿所在部位、大小及侵犯范围而定,对早中期患者力争行根治性胃切除术。术后生存率和手术方式密切相关。     

全胃切除、改良Double tract代胃术治疗老年胃癌68例疗效观察

对68例75岁以上胃癌患者，在全麻下行全胃切除，改良Double tract代胃术，其中根治性切除49例，姑息性切除19例。术后并发症发生率22．1％（15／68），无术中死亡，术后死亡2例（脑梗死1例，肺动脉栓塞1例）。姑息性切除的19例患者17例获随访，1、2、3a总生存率分别为31．2％、5．9％和0。根治性切除的49例患者中45例获随访，1、2、3a总生存率分别为66．7％、42．2％和23．8％。认为胃癌患者行全胃切除，改良Double tract代胃术安全、有效。     

残胃癌12例临床观察

目的 探讨残胃癌的临床特点、早期诊断和外科治疗。方法 对1999—06收治的12例病人进行回顾性分析。结果 本组手术切除率为83．2％，根治切除率为48．5％，Ⅰ、Ⅱ、Ⅲ、Ⅳ期的3年生存率分别为98．2％、65．4％、49．3％和0，Ⅰ期的5年生存率为95．2％。结论 对50岁以上的男性胃部分切除者，建议自术后10年开始每年1次胃镜加活检随诊。外科治疗以根治性全胃切除加D2淋巴清扫术为宜。     

远端胃癌D2根治术中常规胃裸区清扫的临床价值探讨

目的探讨远端胃癌根治术中行胃裸区清扫的临床效果及价值。方法将同期收治的50例远端胃癌(T1～3N0～2M0)患者随机分为观察组和对照组,各25例。两组均行D2根治术;观察组术中行胃裸区常规清扫。观察两组总有效率、围术期并发症及不良反应发生率;随访5 a,观察术后5年生存率、肿瘤术后复发率及转移率及患者生存质量(Spitzer评分)。结果观察组总有效率明显高于对照组(P<0.05),两组围术期并发症及不良反应发生率无明显差异;观察组术后5年生存率、Spitzer评分明显高于对照组,肿瘤复发率及转移率明显低于对照组,P均<0.05。结论胃远端胃癌D2根治术中常规行胃裸区清扫可提高患者5年生存率,明显改善预后。     

70岁以上老年人肺癌273例的外科治疗

目的 分析70岁以上老年人肺癌手术适应证、肺功能保护、围手术期处理以及影响预后的因素。方法 全组273例，年龄70～85岁，平均77．5岁。Ⅰ期85例，Ⅱ期137例，Ⅲ期51例。肺段和楔形切除17例，单纯肺叶切除(包括双叶切除)158例，支气管袖式肺叶切除21例，肺动脉加支气管袖式肺叶切除6例，全肺切除65例，右肺上叶切除加隆突切除重建4例，右肺上、中叶加隆突切除重建2例。结果 并发症发生率43．6％，病死率4．3％，围术期死亡9例(3．3％)，其中循环衰竭5例，呼吸衰竭4例，总5年生存率44．2％，Ⅰ期、Ⅱ期、Ⅲ期患者5年生存率分别为73．2％、32．6％、15．o％，预后危险因素为：长期大量吸烟(P=0．004)、肺癌Ⅲ期(P=0．013)及慢性阻塞性肺部疾病(P=0．042)。结论 70岁以上老年人肺癌肿瘤的侵袭与转移发生较慢，在严格选择手术适应证的前提下，结合术中肺功能保护及周密的围术期处理，患者术后可获得相对良好的远期预后，应采取积极的手术治疗。     

胃癌病人全胃切除、代胃及人工幽门括约肌重建术的远期疗效观察

目的 观察胃癌病人行全胃切除、代胃及人工幽门括约肌重建术的远期疗效。方法 连续5年对应用此法治疗的106例胃癌患者的营养状况、生存率、术后并发症发生率以及术后生活质量等情况进行定期随访。结果 本组患者5年生存率42．5％，碱性反流性食管炎的发生率为0．9％，术后5年胆石症发生率为5．66％，生活质量优良率为89．6％。结论 全胃切除、代胃及人工幽门括约肌重建术治疗进展期胃癌有较好的远期疗效。     

70岁以上老年人肺癌273例的外科治疗

目的分析70岁以上老年人肺癌手术适应证、肺功能保护、围手术期处理以及影响预后的因素。方法全组273例．年龄70～85岁，平均77．5岁。Ⅰ期85例，Ⅱ期137例，Ⅲ期51例。肺段和楔形切除17例，单纯肺叶切除（包括双叶切除）158例，支气管袖式肺叶切除21例，肺动脉加支气管袖式肺叶切除6例，全肺切除65例，右肺上叶切除加隆突切除重建4例，右肺上、中叶加隆突切除重建2例。结果并发症发生率43．6％，病死率4.3％，围术期死亡9例（3．3％），其中循环衰竭5例，呼吸衰竭4例，总5年生存率44．2％，Ⅰ期、Ⅱ期、Ⅲ期患者5年生存率分别为73．2％、32．6％、15.0％．预后危险因素为：长期大量吸烟（P=0．004）、肺癌Ⅲ期（P=0．013）及慢性阻塞性肺部疾病（P=0．042）。结论70岁以上老年人肺癌肿瘤的侵袭与转移发生较慢，在严格选择手术适应证的前提下，结合术中肺功能保护及周密的围术期处理．患者术后可获得相对良好的远期预后，应采取积极的手术治疗。     

老年人胃癌的外科治疗

目的探讨老年胃癌病人临床表现特点及适当的外科治疗方法。方法回顾分析我院1985～2000年收治的年龄70岁以上238例胃癌病人的临床及手术资料。结果老年胃癌发病较隐匿，主要表现为上腹隐痛不适、消瘦、食欲下降、贫血等。多数病人合并有重要器官的慢性病变。手术证实大多数为中晚期胃癌，手术切除166例，切除率为69．7％，其中根治性切除107例，64．5％；姑息性切除59例，35.5％。切除者手术后5年生存率为32．6％，根治性切除达53．7％。姑息性切除平均生存期10．8个月。手术后并发症发生率20．8％。结论老年胃癌由于发病隐匿多为晚期，应提高早期诊断率。要做充分的术前准备及积极的术后处理，大多能耐受手术。     

70岁以上老年人肺癌的外科治疗体会

目的 分析70岁以上老年人肺癌手术适应证、肺功能保护、围手术期处理以及影响预后的因素。方法 全组273例，年龄70～85岁，平均77．5岁。Ⅰ期85例，Ⅱ期137例，Ⅲ期51例。肺段和楔形切除17例，单纯肺叶切除（包括双叶切除）158例，支气管袖式肺叶切除21例，肺动脉加支气管袖式肺叶切除6例，全肺切除65例，右肺上叶切除加隆突切除重建4例，右肺上、中叶加隆突切除重建2例。结果 并发症发生率43．6％，病死率4．3％，围术期死亡9例（3．3％），其中循环衰竭5例，呼吸衰竭4例，总5年生存率44．2％，Ⅰ期、Ⅱ期、Ⅲ期患者5年生存率分别为73．2％、32．6％、15．0％，预后危险因素为：长期大量吸烟（P=0．004）、肺癌Ⅲ期（P=0．013）及慢性阻塞性肺部疾病（P=0．042）。结论 70岁以上老年人肺癌的侵袭与转移发生较慢，在严格选择手术适应证的前提下，结合术中肺功能保护及周密的隔术期处理，患者术后可获得相对良好的远期预后。     

65例高龄肺癌患者的外科治疗及围手术期处理

目的总结高龄肺癌患者外科治疗围手术期和术后并发症处理的经验及影响生存的因素。方法对1999年1月～2006年6月在我科接受手术的70岁以上肺癌患者65例进行回顾性分析。结果65例均在气管插管、静脉复合麻醉下接受全肺切除、肺叶切除、肺叶楔形切除等不同术式的手术治疗,术后早期死亡1例。5年随访率达100％,全组1年生存率为80．0％,3年生存率为38．5％,5年生存率为26．2％。结论高龄肺癌患者常合并或并发各种疾病,手术治疗及积极预防治疗围手术期可能的并发症,是病人长期生存的关键。     

A comparative study of pancreatectomy and pancreas-preserving gastrectomy in advanced gastric carcinomas

BACKGROUND/AIMS: In patients with advanced gastric carcinoma (tumor infiltrating beyond submucosal layer), distal pancreatectomy has been frequently performed simultaneously with gastrectomy for complete removal of the lymph nodes along the splenic artery. However, the possibility of a negative impact has also been reported. To evaluate the effects of distal pancreatectomy with gastrectomy for patients with advanced gastric cancer, we retrospectively analyzed 84 patients who had proximal- or middle-third advanced gastric cancer resected in an institution in Taiwan. METHODOLOGY: From 1988 to 1998, 46 patients who underwent gastrectomy with distal pancreatectomy (DP group) and 38 patients who had pancreas-preserving gastrectomy (PS group) for advanced gastric cancer were reviewed. The clinicopathological details and survival rates were compared between the two groups. RESULTS: In terms of clinicopathological factors and operative mortality, there were no significantly statistical differences between the patients who did and did not undergo distal pancreatectomy. The cumulative 5-year survival rate for the DP group was 35.6%, whereas the 5-year survival rate for the PS group was 42.4% (P=0.6224). In contrast, the operative morbidity was significantly higher in patients who had distal pancreatectomy (P=0.008). CONCLUSIONS: Since distal pancreatectomy does not benefit patients with advanced gastric cancer, this procedure should not be regarded as routine in a radical resection.     

Gastric cancer in elderly patients--results of surgical treatment

Between 1972 and 1984, a total of 848 patients underwent gastrectomies for gastric cancer. One hundred and thirty-nine patients (16%) were aged 70 and over (elderly group), the remaining 709 being under 70 (control group). The operative morbidity and mortality rates were 29.5% and 4.3% in the elderly group, as compared with 23.0% and 1.8% in the controls. The 5-year survival rate was 47.2 +/- 5.3% in the former and 53.9 +/- 2.4% in the latter. In neither comparison was the difference statistically significant. The mortality rate after total gastrectomy in the elderly group was 8.6% for the overall period, but it has reduced to 5.3% in the past five years. These data would seem to justify a liberalized indication for radical surgery in elderly patients. In the elderly group, the mean operating time and the amount of bleeding in the operative-death patients significantly exceeded those in the surviving patients. Non-curative resection in elderly patients could not be generally accepted, since the mean survival time was only 11 months, with high morbidity (40.5%) and mortality rates (8.1%).     

Long-term survival is improved by an extended lymph node dissection in potentially curable gastric cancer

BACKGROUND/AIMS: This study was planned to investigate the therapeutic value of performing an extended lymphadenectomy in potentially curable gastric cancer. METHODOLOGY: A prospective gastric cancer database was used. In total 114 gastric cancer patients (85 male, 29 female) who underwent a gastrectomy for curative intent from 1992 through 1999 were included to this study. Morbidity and mortality, survival rates and factors affecting survival were evaluated. RESULTS: Sixty-six (58%) patients had limited (D1) and 48 (42%) patients had extended (D2) gastric resections. The operative mortality rates were 12% and 8% and the postoperative complication rates were 33% and 25% in the D1 and D2 lymphadenectomy patients, respectively. The mean follow-up period was 34 (range: 8-94) months. The overall mean survival was 32 months (25 months in D1 group, 46 months in D2 group) (P < 0.05). The duration of symptoms, the presence of postoperative complications, the extent of lymphadenectomy, the operative curability and the site of the tumor were all found to be independent prognostic factors based on a multivariate analysis. CONCLUSIONS: This study demonstrates that an extended lymph node dissection improves long-term survival without increasing postoperative morbidity and mortality in patients with potentially curable gastric cancer.     

老年人胃癌的临床特点及预后因素分析

目的分析老年人胃癌的临床特点以及影响预后的各种因素，更好的认识老年人胃癌的特征，为我们的诊断和治疗提供参考，从而改善他们的生存率。方法收集1994～1998年我院收治的老年人(≥65岁)胃癌356例．对预后进行单因素和Cox回归模型分析。结果老年人胃癌患者多为男性，症状以上腹疼痛、食欲减退和饱胀不适多见，病程长，确诊时多为晚期。多因素分析显示，年龄、分期、手术切除与预后有关。结论对于老年人胃癌早检查．早诊断是关键。尽可能实施D2式淋巴结清扫的胃癌根治术对提高五年生存率是十分必要的，对无根治手术条件的病人，姑息性切除手术也能改善预后。     

Treatment of early gastric cancer in the elderly patient: results of EMR and gastrectomy at a national referral center in Japan

BACKGROUND: The Japanese population is rapidly aging, and the actual number of elderly patients with gastric cancer, including early cancer, has been increasing, even though the standardized incidence of gastric cancer in the population is decreasing. The optimal treatment for these patients remains a challenge to the surgeon. The aim of this retrospective analysis was to describe the results of gastrectomy and EMR for early gastric cancer in elderly patients (80 years of age and over). METHODS: This is a retrospective review of 93 elderly patients who had undergone gastrectomy or EMR at the National Cancer Center Hospital for early gastric cancer. EMR was performed aiming en bloc local resection with a clear curative margin (R0). The clinicopathologic characteristics, comorbidity, postoperative mortality, and outcome were recorded. RESULTS: Gastrectomy was performed in 44 patients (surgery group) and EMR in 49 patients (EMR group). There were significant differences in mean tumor size (p < 0.05), histologic type (p < 0.05), and depth of tumor invasion (p < 0.05) between the two groups. There was no significant difference in comorbidity between the two groups. No operative death was reported in either group. In the EMR group, 7 patients were reported to have recurrence of local disease and two patients died of advanced disease. There were no significant differences in the overall 3-year survival rate or the 5-year survival rate between the surgery group and EMR group (73.5% vs. 82.5% and 55.0% vs. 62.5%, respectively). CONCLUSIONS: EMR (R0) resection was performed safely in the elderly, and the overall results were excellent, the same as the results with gastrectomy. Gastrectomy can still be performed if EMR is unsuccessful.     

Pancreaticoduodenectomy for advanced gastric cancer with pancreaticoduodenal region involvement

AIM：To characterize the factors of the improved survival following combined pancreaticoduodenectomy（PD） and gastrectomy for the treatment of advanced gastric cancer with pancreaticoduodenal region involvement.
METHODS：From 1995 to 2004,53 patients with primary gastric cancer were diagnosed with synchronous（n = 44） or metachronous（n = 9） pancreaticoduodenal region involvement.Of these,17 patients（32%） underwent total gastrectomy（TG） or distal subtotal gastrectomy（SG） combined with PD simultaneously.The preoperative demographic,clinical information,clinicopathologic features and the surgical results of these 17 patients were considered as factors influencing survival and were analyzed by the Kaplan-Meier method with log-rank comparison.
RESULTS：The actual 1-and 3-year survival rates of these 17 patients after resection were 77% and 34%,respectively,and three patients survived for more than 5 years after surgery.The tumor-free resection margin（P = 0.0174） and a well-differentiated histologic type（P = 0.0011） were significant prognostic factors on univariate analysis.No mortality occurred within one mo after operation,postoperative weight loss of different degree was present in all the patients with TG and 12 cases had other complications.There were 9（53%） cases of recurrence in 5-48 mo after operation.The survival rate in the palliative and explorative group was significantly（P = 0.0064） lower than in the combined PD group.
CONCLUSION： Judicious use of en bloc PD and gastrectomy and strictly preventing postoperative complications may improve the long-term survival for advanced gastric cancer patients with pancreaticoduodenal region involvement. Well-differentiated histology and negative resection margin are the most important predictors of long survival.     

Evaluation of intraoperative radiotherapy for gastric carcinoma with D2 and D3 surgical resection

INTRODUCTION The fate of patients after surgical removal of a gastric carcinoma is determined to a large degree by regional failure of the operation (e.g. tumor recurrence in the tumor bed or in an adjacent structure). This is true for palliative resectio…     

老年乳腺癌203例外科治疗分析

目的评价老年妇女乳腺癌的手术效果，并重视其外科问题。方法分析并复查２０３例临床和随访资料。结果本组２０３例女性患者均进行手术。以改良根治术为主共９６例，占４７％；根治术５２例；扩大根治术５例；全乳切除术３９例；姑息性手术６例；电化疗术５例。本组术后３年、５年生存率分别为７７．２％和６８．２％。合并症７１％，术后并发症发生率１６．３％，术后死亡率１．５％。结论（１）老年乳腺癌经手术可改善生活质量，并有较高生存率，高龄并非是手术禁忌证。（２）内外科配合，重视并处理好合并症和术后并发症。（３）对每个患者应采取合适的术式和麻醉方法，术后精心护理。     

Surgical treatment and prognosis of gastric cancer in 2,613 patients

AIM: To analyze the factors influencing the prognosis of patients with gastric cancer after surgical treatment, in order to optimize the surgical procedures.METHODS: A retrospective study of 2 613 consecutive patients with gastric cancer was performed. Of these patients, 2 301 (88.1%) received operations; 196 explorative laparotorny (EL), 130 by-pass procedure (BPP), and 1 975 surgical resection of the tumors (891 palliative resection and 1 084 curative resection). The survival rate was calculated by theactuarial life table method, and the prognostic factors were evaluated using the Cox regression proportional hazard model.RESULTS: Of the patients, 2 450 (93.8%) were followed-up.The median survival period was 4.6 mo for patients without operation, 5.2 mo for EL, 6.4 mo for BPP, and 15.2 mo for palliative resection (P = 0.0001). Of the patients with surgical resection of the tumors, the overall 1, 3 and 5-yearsurvival rates after were 82.7%, 46.3% and 31.1%,respectively, with the 5-year survival rate being 51.2% in patients with curative resection, and 7.8% for those with palliative resection. The 5-year survival rate was 32.5% for patients with total gastrectorny, and 28.3% for those with total gastrectomy plus resection of the adjacent organs. The factors that independently correlated with poor survival included advanced stage, upper third location, palliative resection, poor differentiation, type IV of Borrman nclassification, tumor metastasis (N3), tumor invasion into the serosa and contiguous structure, proximal subtotal gastrectomy for upper third carcinoma and D1 lymphadenectomy aftercurative treatment.CONCLUSION: The primary lesion should be resected as long as the local condition permitted for stage III and IV tumors, in order to prolong the patients‘ survival and improve their quality of life after operation. Total gastrectomy is indicated for carcinomas in the cardia and fundus, and gastric cancer involving the adjacent organs without distant metastasis requires gastrectomy with resection of the involved organs.