西沃特II食管胃结癌:全胃切除术还是食管切除术?
Durval Renato Wohnrath1, Raphael de Oliveira E Silva2, Raphael Leonardo Cunha Araujo3
1Barretos Cancer Center, Department of Upper Gastrointestinal and Hepato-Pancreatic-Biliary Surgery - Barretos (SP), Brazil.
概括
这项研究建议避免对Siewert II食管胃结癌进行不必要的食管切除术. 在外科手术中,冷截面可以指导决定是否进行全胃切除与远端食道切除或全/次全食道切除和近端胃切除,从而有可能降低患病率.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 在瘤学瘤学.
背景情况:
- 对于Siewert II食管胃结癌 (EJC) 的手术方法仍然存在争议,特别是在边缘控制,重建和淋巴切除术方面.
- 预测需要完全/次完全食道切除和近端胃切除 (TEPG) 与完全胃切除与远端食道切除 (TGDE) 的需求是具有挑战性的.
- 从历史上看,TEPG的并发症率更高,影响了全身治疗和长期结果.
研究的目的:
- 描述Siewert II EGJ瘤的手术策略.
- 利用手术内冷部分来指导TGDE和TEPG之间的决定.
- 为了优化食管胃结癌的手术结果.
主要方法:
- 拉巴切除术具有更大的曲率脱落,保留了关键的胃动脉.
- 用于淋巴结收获的食道间隙的剖析.
- 在外科手术中结了远端食道的截面,以指导外科手术 (TGDE与TEPG).
主要成果:
- 在38名Siewert II患者中,26人 (69%) 接受了TGDE,12人 (31%) 接受了TEPG.
- 尽管TEPG组的并发症率较高,阳性边缘和生存时间较短的趋势,但没有发现统计学上显著的差异.
- 该研究发现,这两种手术之间的发病率没有显著差异.
结论:
- 在Siewert II EGJ癌症中,可以避免不必要的食管切除术.
- 选择一种不太病态的手术 (TGDE) 可能不会危及手术或瘤的结果.
- 可能需要进一步的研究来探索影响观察结果的潜在II型错误.
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