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1.
Chen Li Min Yan Jun Chen Min Xiang Zheng Gang Zhu Hao Ran Yin Yan Zheng Lin 《Journal of gastrointestinal surgery》2010,14(2):282-288
Background
The prognosis for gastric cancer patients with distant metastasis is very poor. The purpose of this study was to evaluate the survival benefit of non-curative gastrectomy for gastric cancer patients with synchronous distant metastasis. 相似文献2.
3.
Fernández R Vizoso F Rodríguez JC Merino AM González LO Quintela I Andicoechea A Truan N Díez MC 《Annals of surgical oncology》2000,7(7):508-514
Background: In this study we evaluated the expression and clinical significance of pepsinogen C, an aspartic proteinase involved in the digestion of proteins in the stomach, in patients with gastric cancer.Methods: Pepsinogen C expression was examined by immunohistochemical methods in a series of 95 gastric carcinomas. The prognostic value of pepsinogen C was retrospectively evaluated by multivariate analysis taking into account conventional prognostic parameters. Follow-up period of patients was 21.4 months.Results: A total of 25 (26.3%) gastric carcinomas stained positively for pepsinogen C. The percentage of pepsinogen C-positive tumors was higher in well-differentiated (50%) than in moderately differentiated (19.5%) and poorly differentiated (21.9%) tumors (P < .05). Similarly, significant differences in pepsinogen C immunostaining were found between node-negative and node-positive tumors (47.1% vs. 14.7%; P < .001). In addition, statistical analysis revealed that pepsinogen C expression was associated with clinical outcome in gastric cancer patients. Low pepsinogen C levels predicted short overall survival periods in the overall group of patients with gastric cancer (P < .001), and in 71 patients with resectable carcinomas (P < .005). Multivariate analysis according to Coxs model indicated that pepsinogen C immunostaining was an independent predictor of outcome for both overall and resectable gastric cancer patients (P < .05, for both).Conclusions: The expression of pepsinogen C in gastric cancer may represent a useful biological marker able to identify subgroups of patients with different clinical outcomes. 相似文献
4.
Gastric Emptying After Pylorus-Preserving Gastrectomy in Comparison with Conventional Subtotal Gastrectomy for Early Gastric Carcinoma 总被引:5,自引:0,他引:5
Toshio Imada Yasushi Rino Makoto Takahashi Shinsuke Hatori Jyun-ichi Tanaka Manabu Shiozawa Chao Chin Yuji Yamamoto Tomishige Amano Kazuo Nakamura 《Surgery today》1998,28(2):135-138
(Received for publication on Oct. 14, 1996; accepted on May 12, 1997) 相似文献
5.
Arfon Powell Alexandra Harriet Coxon Neil Patel David Chan Adam Christian Wyn Lewis 《Journal of gastrointestinal surgery》2018,22(9):1516-1527
Background
Survival and relapse after gastric cancer surgery are largely attributed to tumor biology and surgical radicality; yet, other prognostic factors have been reported, including respiratory sepsis and anastomotic leakage, but not global morbidity severity score (MSS). The hypothesis tested was that MSS would be associated with both disease-free (DFS) and overall survival (OS).Methods
Consecutive 373 patients undergoing potentially curative surgery for gastric adenocarcinoma between 2004 and 2016 in a UK cancer network were studied. Complications were defined prospectively as any deviation from a pre-determined post-operative course within 30 days of surgery and classified according to the Clavien-Dindo severity classification (CDSC). Primary outcome measures were DFS and OS.Results
Post-operative complications were identified in 127 (34.0%) patients, which was associated with 9 (2.4%) post-operative deaths. Five-year DFS and OS were 35.9 and 38.5% for patients with a post-operative complication compared with 59.5 and 61.5% in controls (p?<?0.001, p?=?0.001, respectively). On multivariable DFS analysis, post-operative morbidity [hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.06–2.50, p?=?0.026] was independently associated with poor survival. On multivariable OS analysis, post-operative morbidity HR 2.25 (95% CI 1.04–4.85, p?=?0.039) and CDSC HR 1.76 (95% CI 1.35–2.29, p?<?0.001) were independently associated with poor survival. These associations were also observed in patients with TNM stage I and II disease with morbidity HR 7.06 (95% CI 1.89–26.38, p?=?0.004) and CDSC HR 2.93 (95% CI 1.89–4.55, p?<?0.001) offering independent prognostic value.Conclusion
Post-operative CDSC was an important independent prognostic factor after potentially curative gastrectomy for carcinoma associated with both DFS and OS. Prehabilitation strategies to minimize complications are warranted.6.
Prognostic Significance of Vascular Endothelial Growth Factor D in Gastric Carcinoma 总被引:5,自引:0,他引:5
Shida A Fujioka S Ishibashi Y Kobayashi K Nimura H Mitsumori N Suzuki Y Kawakami M Urashima M Yanaga K 《World journal of surgery》2005,29(12):1600-1607
The angiogenic factor called vascular endothelial growth factor (VEGF)-D is a ligand for VEGF receptor-2 (VEGFR-2/KDR) and
receptor-3 (VEGFR-3/Flt-4). It is implicated in the development of lymphatic vessels and promotion of lymphatic metastasis.
The purpose of this study was to investigate the prognostic significance of VEGF-D expression in patients with gastric carcinoma.
We assessed the expression of VEGF-D in gastric carcinoma by immunohistochemistry on 143 consecutive patients’ stored sections
and evaluated the lymphatic vessel count (LVC) in tumors using the novel selective lymphatic endothelium marker D2-40. VEGF-D
expression was observed in 55 (39%) tumor sections. The expression of VEGF-D correlated significantly with tumor size, T of
the TNM classification, lymphatic and venous system invasion, LVC, lymph node metastasis, M of TNM, and pTNM stage. Multivariate
analysis indicated that VEGF-D expression was an independent prognostic factor for both relapse-free survival (RFS) and overall
survival (OS). Our data indicate the involvement of VEGF-D in tumor progression via lymphoangiogenic pathways. Practically,
VEGF-D expression can be useful for predicting RFS and OS in patients with gastric carcinoma. 相似文献
7.
腹腔镜胃癌D2根治术在进展期胃癌中的应用探讨 总被引:5,自引:3,他引:5
目的探讨腹腔镜下胃癌D2根治术治疗进展期胃癌的可行性。方法对2008年1~8月32例进展期胃癌行腹腔镜下D,根治术,根治性远端胃大部切除术清扫1、3、4、5、6、7、8、9、11p、12a、14v组淋巴结;根治性近端胃大部切除术清扫1、2、3、4、7、8、9、10、11组淋巴结;根治性全胃切除术清扫1、2、3、4、5、6、7、8、9、10、11、12a、14v组淋巴结;所有患者均于上腹部做辅助小切口行病灶移除及消化道重建。结果32例均顺利完成腹腔镜下胃癌D2根治手术,无中转开腹,其中根治性远端胃切除18例,根治性近端胃切除2例,根治性全胃切除12例。远、近端胃根治性切除术时间250~390min,平均325min;全胃根治性切除300—450min,平均347min。术中出血量:远、近端胃根治性切除术50~250ml,全胃根治性切除术60—350ml,术中均未输血。所有标本切缘均阴性。排气时间24—72h,平均38h;进流质时间2~5d,平均2.8d;无吻合口漏等手术相关并发症。30例随访1~8个月,未见复发和转移,亦未发生切口和穿刺口种植。结论腹腔镜下胃癌D2根治术应用于治疗进展期胃癌,安全、可行、有效、创伤小且近期效果良好。 相似文献
8.
Masanori Tokunaga Rie Makuuchi Yuichiro Miki Yutaka Tanizawa Etsuro Bando Taiichi Kawamura Masanori Terashima 《World journal of surgery》2016,40(5):1172-1177
Background and objectives
Gastrectomy is sometimes performed even in patients with incurable factors, particularly when they have urgent symptoms. The aim of this study was to clarify the clinicopathological characteristics of patients undergoing palliative gastrectomy and to identify prognostic factors.Methods
This study included consecutive 137 gastric cancer patients with urgent symptoms who underwent gastrectomy with macroscopic residual tumor at Shizuoka Cancer Center. Clinicopathological characteristics and surgical outcomes were investigated. In addition, we used the Cox proportional hazards model to identify independent prognostic factors.Results
Of 137 patients, urgent symptoms were bleeding in 58 patients and stenosis in 112 patients. Postoperative complications were observed in 58 patients (42 %). Chemotherapy was given after surgery in 94 patients (70 %). Median survival time for all patients was 9.9 months, and was longer in patients receiving chemotherapy (11.1 months) than in those not receiving chemotherapy (6.8 months; p = 0.002). Multivariate analysis identified macroscopic type (hazard ratio, 0.471; 95 % confidence interval, 0.364–0.927) as an independent prognostic factor.Conclusions
The postoperative complication rate was high and survival outcome was poor in patients undergoing palliative gastrectomy. Postoperative chemotherapy may carry a better survival outcome, so we should try to give chemotherapy after palliative gastrectomy.9.
目的 探讨腹腔镜辅助下胃癌D2根治术治疗胃癌的可行性、安全性和根治性.方法 回顾性分析2011年5月~2012年9月进行的112例胃癌根治术,由患者选择手术方式,腹腔镜组50例,开腹组62例.比较2组手术时间、术中出血量、淋巴结清扫数量、术后肛门排气时间、术后住院时间和术后并发症.结果 腹腔镜组均在腹腔镜辅助下完成根治性胃切除和淋巴结清扫,无中转开腹.腹腔镜组手术时间[(231.8±44.2)min]、清扫淋巴结数[(18.4±5.5)枚]与开腹组[(223.6±36.9)min、(20.5±5.9)枚]比较,差异无显著性(t=1.070,P=0.287;t=-1.930,P=0.056).腹腔镜组术中出血量[(160.5±136.4)ml]、术后肛门排气时间[(3.0±1.4)d]、术后住院时间[(11.5±2.3)d]均小于开腹组[(231.6±121.7)ml、(4.8±2.3)d、(14.3±3.9)d],差异有显著性(t=-2.912,P=0.004;t=-4.854,P=0.000;t=-4.484,P=0.000).腹腔镜组术后并发症发生率为12.0%(6/50),低于开腹组(21.0%,13/62),但差异无显著性(χ2=1.580,P=0.209).两组均无围手术期死亡,术后病理分期差异无显著性(χ2=2.064,P=0.356).结论 熟悉局部解剖与淋巴结清扫技巧,腹腔镜辅助下胃癌D2根治手术是安全可行的,且具有创伤小、并发症少、恢复快等优点. 相似文献
10.
Prognostic Significance of E-cadherin Expression and Peripheral Blood Micrometastasis in Gastric Carcinoma Patients 总被引:1,自引:0,他引:1
Abeer A. Saad Nahla M. Awed Nashwa N. A. Abd Elkerim Dina EL-Shennawy Marian A. Alfons Mohamed E. Elserafy Yaser W. Darwish Eman M. F. Barakat Sahar S. Ezz-Elarab 《Annals of surgical oncology》2010,17(11):3059-3067
Background
The primary objective is to evaluate the prognostic value of E-cadherin (E-cad) expression and peripheral blood micrometastasis (PBMM) in gastric carcinoma. Secondary objective is to study the association between these 2 markers and the clinicopathological features of the patients. 相似文献11.
胃癌胃切除术后营养支持的护理 总被引:3,自引:1,他引:2
李焕联 《岭南现代临床外科》2004,4(3):238-239
目的:总结胃癌胃切除术后营养支持的护理经验。方法:回顾性分析105例胃癌胃切除术后患者实施营养支持的护理资料。应用TPN时的护理应注意保护血管.做好血糖的监测.严格控制入速:应用TEN时的护理注意做好空肠造瘘管的护理,严格掌握TEN要从低速、低浓度、小剂量开始:做好口服饮食指导。结果:75例患者于营养支持第一阶段行。TPN治疗期间5例发生代谢性并发症,其中3例发生高血糖反应,2例发生低血糖反应:38例患者于营养支持第二阶段行TEN治疗期间6例出现胃肠道反应:全部病例营养状况均有不同程度改善,92例治愈出院,13例好转出院,无一例死亡。结论:做好营养支持的护理工作是改善胃癌胃切除术后患者预后的重要措施之一。 相似文献
12.
The Significance of Perineural Invasion as a Prognostic Factor in Patients with Gastric Carcinoma 总被引:6,自引:0,他引:6
Purpose: Few studies have investigated the prognostic significance of perineural invasion (PNI) in gastric cancer. Therefore, we examined
the association between PNI and clinicopathological factors and the effect of PNI on overall survival in patients with gastric
carcinoma.
Methods: Paraffin sections of surgical specimens from 354 patients who underwent gastric resection were stained with hematoxylin and
eosin. PNI was assessed histologically as positive when cancer cells were seen in the perineurium or neural fascicles. Survival
analysis was done in 219 patients with T2,3,4 tumors who underwent potentially curative resection. Data were collected prospectively.
Results: PNI was positive in 211 of the 354 patients (59.6%). The ratio of undifferentiated tumors, tumors with vascular invasion,
and lymph node metastasis was significantly higher in the PNI-positive patients than in the PNI-negative patients (P < 0.0001 for all three associations). As the depth of mural invasion increased, so did PNI positivity (P < 0.0001). The overall survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients
in the univariate analysis (P = 0.0009). However, PNI had no independent prognostic significance in the multivariate Cox proportional hazards model analysis.
When the patients were separated into subgroups, PNI had prognostic value in patients with T3 tumors (P = 0.036) and no lymph node metastasis (P = 0.005) in the univariate analysis, but no prognostic significance in the multivariate analysis.
Conclusions: Although the incidence of PNI is high in gastric carcinoma and increases with the progression of disease, it does not provide
any additional information to the classical prognostic parameters.
Received: March 4, 2002 / Accepted: July 2, 2002
Reprint requests to: N. Duraker, Ata-2 Sitesi Manolya Cad., ?am Sokak B-5 9-A Da:10, ?engelk?y 81210, Istanbul, Turkey 相似文献
13.
超声刀结合单极电凝应用于腹腔镜胃癌根治术的评价 总被引:1,自引:0,他引:1
目的评价腹腔镜胃癌根治术中联合应用超声刀及单极电凝的效果。方法回顾分析2010年1月~2011年3月75例腹腔镜胃癌D2根治术的临床资料,前39例单纯使用超声刀(超声刀组),后36例联合应用超声刀与单极电凝(联合组)。比较2组手术时间、术中出血量、平均清扫淋巴结个数、术后引流量及术后并发症方面的差异。结果与超声刀组相比,联合组术中出血少[(274±122)ml vs.(186±90)ml,t=3.530,P=0.000],手术时间短[(347±38)min vs.(310±23)min,t=5.049,P=0.000],2组清扫淋巴结个数、术后引流量及并发症发生率差异无显著性(P〉0.05)。结论超声刀与单极电凝联合应用于腹腔镜胃癌根治术,能够充分发挥两种器械的优势,缩短手术时间,减少术中出血,利于淋巴清扫。 相似文献
14.
Ryu KW Choi IJ Doh YW Kook MC Kim CG Park HJ Lee JH Lee JS Lee JY Kim YW Bae JM 《Annals of surgical oncology》2007,14(12):3428-3434
Background Endoscopic resection (ER) is an effective treatment for early gastric cancer (EGC) without lymph node metastasis. However,
after ER additional surgery may be needed to manage the risks presented by residual cancer or lymph node metastasis.
Methods ER was performed on 344 gastric adenocarcinomas between November 2001 and April 2006 at the Korean National Cancer Center
under the strict pre-procedural indication. The authors performed operations in 43 patients due to: residual mucosal cancer,
a mucosal cancer larger than 3 cm, or a submucosal cancer regardless of size or margin involvement. ER and surgical specimens
were reviewed and analyzed for residual cancer and lymph node metastasis.
Results Based on examinations of ER specimens, cancer was confined to the mucosal layer in 15 patients (34.9%) and invaded the submucosal
layer in 28 patients (65.1%). Surgical specimens showed residual cancer in 17 patients (39.5%) and lymph node metastasis in
four (9.3%). Neither residual cancer nor lymph node metastasis was found in patients with less than 500 μm submucosal invasion
without margin involvement in ER specimens. In three of four patients with lymph node metastasis, the depth of submucosal
invasion was 500 μm or more; the remaining patient had a 4-cm-sized differentiated mucosal cancer.
Conclusions When a pathologic evaluation of an ER specimen reveals more than 500 μm of submucosal invasion or a mucosal cancer of larger
than 3 cm, surgery should be considered due to the risk of lymph node metastasis. 相似文献
15.
Prithiviraj Nabi Shivanshu Mishra Hirdaya Hulas Nag 《The Indian journal of surgery》2018,80(5):452-456
Radical gastrectomy with N2 lymphadenectomy (D2 gastrectomy) has been shown to have a survival advantage in Japanese and western trials, but Indian experience is limited. A retrospective analysis of prospectively collected data of patients with carcinoma of the stomach considered for surgery from 2009 to 2014. The operative details, pathological TNM stage and survival were analysed. Total number of patients was 58, out of which 34 patients (59%) had radical gastrectomy with N2 lymphadenectomy (D2-gastrectomy), 11 (18%) patients had locally advanced disease and 13 (22%) patients had metastatic disease. Mean blood loss was 180 ml (±85 SD), and mean duration of surgery was 286 (±65 SD) minutes. Median length of hospital stay was 8 days (6–17 days), 30-day mortality was zero and a total of four patients (12%) had grades III to IV complications (Clavien-Dindo classification). The median number of lymph nodes removed was 18 (11–31). Pathological TNM stage was II in 8%, III in 47% and IV in 41%. The median survival of patients undergoing curative resection was 28 months, and it was 6 months in patients without curative resection (P < 0.001). Radical gastrectomy (D2) may improve the survival of Indian patients with potentially curable gastric cancer; the outcome of surgery is dependent upon T stage and lymph node metastasis. 相似文献
16.
Takeshi Kubota MD PhD Naoki Hiki MD PhD Takeshi Sano MD PhD Shogo Nomura MSc Souya Nunobe MD PhD Koshi Kumagai MD PhD Susumu Aikou MD PhD Ryohei Watanabe MD PhD Toshiyuki Kosuga MD PhD Toshiharu Yamaguchi MD PhD 《Annals of surgical oncology》2014,21(3):891-898
Background
Postoperative complications such as anastomotic leakage were reported to be a major independent prognostic factor for long-term survival in gastrointestinal malignancies. This study sought to clarify the prognostic significance of postoperative inflammatory complications specifically for patients with gastric cancer.Methods
This study included 1,395 patients who underwent curative resection for gastric cancer from 2005 to 2008. Complications were evaluated according to the Clavien-Dindo classification. Overall survival (OS) and disease-specific mortality (DSM) were compared between complication and no-complication groups. Presence of complications was modeled by the Cox proportional hazard model for OS and the Fine and Gray competing risk regression model for DSM to assess the correlation between complication and prognosis.Results
The median follow-up time was 3.1 years. Two hundred seven patients (14.8 %) had complications of grade 2 or higher. Of 131 patients who died within this period, 87 died of gastric cancer. The 3-year OS in the complication group was 84.1 % compared to 93.1 % in the no-complication group (P < 0.0001). The cumulative incidence of DSM was also significantly worse in patients with complications (P < 0.0001). Multivariate analysis identified the same significant increasing risk of complication for both OS (hazard ratio 1.88; 95 % confidence interval 1.26–2.80) and DSM (hazard ratio 1.90; 95 % confidence interval 1.19–3.02).Conclusions
Postoperative complications that can cause prolonged inflammation have an obvious impact not only on the OS but also on the DSM of patients with gastric cancer even if the tumor is resected curatively. 相似文献17.
Subtotal Gastrectomy for Gastric Ulcer 总被引:3,自引:1,他引:2
Ransom HK 《Annals of surgery》1947,126(5):633-652
18.
目的 探讨胃癌术后影响胃癌患者生存的因素.方法 将2004年1月至2009年12月期间在笔者所在医院行手术治疗并获随访的351例胃癌患者作为研究对象,对其临床病理资料及随访资料进行单因素和多因素分析.结果 单因素分析显示患者年龄以及肿瘤部位、T分期、N分期、TNM分期和分化程度与预后有关(P<0.05);多因素分析显示肿瘤部位、T分期、N分期和术后化疗是影响胃癌术后生存率的独立因素(P<0.05).结论 肿瘤部位、浸润深度、淋巴结转移率及术后辅助化疗是影响胃癌术后生存的重要因素.对于有淋巴结转移或处于TNMⅢ期的胃癌患者,术后化疗可以提高其生存率. 相似文献
19.
Justin Davies David Johnston Henry Sue-Ling Sheila Young John May John Griffith Glenn Miller Iain Martin 《World journal of surgery》1998,22(10):1048-1055
de principe
in the treatment of gastric carcinoma, wherever the tumor may be sited in the stomach, remains controversial. The advocates
of TG contend that when it can be performed safely, with relatively low operative mortality and morbidity, it yields better
long-term survival than STG. Most surgeons, however, believe that the routine use of TG increases both operative mortality
and morbidity and the risk of nutritional deficiency in the long term, without improving survival. TG may also be associated
with poorer outcome in terms of quality of life (QOL), but the evidence for this is tenuous. Forty-seven consecutive patients
who had undergone potentially curative (R0) gastric resection for carcinoma were studied: 26 had undergone TG and 21 STG.
A radical D2 lymph node dissection had been performed in each, and all patients were free from recurrence at the time of the
study. QOL was measured before operation and 1, 3, 6, and 12 months after operation by means of five questionnaires to measure
functional outcome: the Rotterdam symptom checklist (RSCL), the Troidl index, the hospital anxiety and depression (HAD) scale,
activities of daily living score, and Visick grades. Before operation there was no significant difference in QOL between the
two groups of patients. At 1 year after operation, however, patients who had undergone STG had a significantly better QOL
than patients who had undergone TG: Their median RSCL score was lower (10 versus 19 respectively,
p
< 0.05), and their Troidl index was higher (11 versus 9 respectively,
p
< 0.05). The QOL of patients who underwent STG was also significantly better after operation than it had been before operation,
whereas the QOL of the TG group was not significantly better after operation than before operation. The QOL of patients was
found to be significantly better after STG than after TG for gastric carcinoma. Because operative mortality is greater and
long-term survival is no better after TG than after STG, the latter is recommended as the treatment of choice for tumors of
the distal stomach. 相似文献
20.
Quality of Life after Gastrectomy for Gastric Carcinoma: Controlled Study of Reconstructive Procedures 总被引:10,自引:0,他引:10
Jan Svedlund Marianne Sullivan Bengt Liedman Lars Lundell Ingemar Sjödin 《World journal of surgery》1997,21(4):422-433
n
= 64) eligible for curative
gastric cancer surgery were randomized to have either a total
(
n
= 31) or subtotal (
n
= 13)
gastrectomy or a jejunal S-shaped pouch (
n
= 20) implanted as a gastric substitute. The quality-of-life evaluation
was based on a battery of questionnaires covering both general and
specific aspects of life. The patients were rated by one of two
psychiatrists who were blinded to the patients’ group affiliation.
Assessments were made on three occasions: during the week prior to
surgery and 3 and 12 months after the surgical intervention. The
postoperative complication and mortality rates were similar in all
treatment groups, with few serious complications recorded. Irrespective
of type of treatment, the patients suffered from alimentary symptoms
and functional limitations in everyday life, whereas their mental
well-being improved after surgery. Patients who underwent subtotal
gastrectomy had the best outcome, especially with respect to complaints
of diarrhea. Patients given a gastric substitute after gastrectomy
showed no difference from those who had only a total gastrectomy. We
conclude that despite significant unfavorable consequences that follow
gastrectomy, patients recover with an improved mental status. A pouch
reconstruction after total gastrectomy does not improve quality of
life, but a subtotal gastrectomy has advantages that must be considered
when the procedure is clinically feasible. 相似文献