在早期胃癌中确保负近位边缘的临床策略
Jae Hun Chung1, Dong Won Im1, Dae-Gon Ryu2
1Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Medicine
|October 6, 2023
概括
在早期的胃癌手术中,获得足够的近端切除边缘 (PRM) 是至关重要的. 年轻的年龄和较大的瘤大小等因素预测不完整的PRM,需要仔细的手术前评估和可能更积极的切除.
科学领域:
- 在瘤学瘤学.
- 外科胃肠道外科手术
背景情况:
- 确保适当的近端切除边缘 (PRM) 对胃癌治疗中的瘤安全至关重要.
- 不完整的PRM可以导致积极的边际,并影响患者的结果.
研究的目的:
- 调查与早期胃癌中不完全PRM长度小于2厘米相关的临床病理特征.
- 在早期胃癌患者中确定不完整PRM和积极边缘的风险因素.
主要方法:
- 对1493名患者的临床病理学数据的回顾性审查,这些患者因早期胃癌而接受了亚总胃切除术 (2012-2021).
- 根据PRM长度 (<2厘米与≥2厘米) 将患者分为组.
- 进行了单变量和多变量分析,以确定导致不完整PRM和正边缘的因素.
主要成果:
- 17.9%的患者的PRM长度小于2厘米.
- 多变量分析确定年龄<50,手术前内镜瘤大小≥3厘米,大小差异≥2厘米,以及较小曲率的中体瘤作为PRM<2厘米的显著预测因素.
- 不完整的PRM是阳性相对PRM (1.6%的患者) 的唯一危险因素.
结论:
- 准确的手术前内镜评估瘤大小和位置对于早期胃癌的手术规划至关重要.
- 具有特定风险因素的患者 (年龄<50岁,较大的瘤大小,大小差异,特定瘤位置) 可能会从更积极的切除策略中受益,以确保足够的PRM.
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