Surgical strategy for gastric cancer patients with liver cirrhosis: A retrospective cohort study

INTERNATIONAL JOURNAL OF SURGERY

卷:12

Article

Guo, Fenghua^1,2,4  Ma, Shulan^3,4  Yang, Shuo¹  Dong, Yuanqiang¹  Luo, Fen^1,2  Wang, Zhiming^1,2,4 

[1] Fudan Univ, Shanghai Med Coll, Huashan Hosp, Dept Gen Surg, Shanghai 200010, Peoples R China

[2] Fudan Univ, Shanghai Med Coll, Huashan Hosp, Surg Lab, Shanghai 200010, Peoples R China

[3] Fudan Univ, Shanghai Med Coll, Huashan North Hosp, Dept Gynecol, Shanghai 201907, Peoples R China

[4] Fudan Univ, Shanghai Med Coll, Huashan North Hosp, Cent Lab, Shanghai 201907, Peoples R China

关键词: Stomach neoplasms;    Liver cirrhosis;    Gastrectomy;    Lymph node excision;   

DOI  :  10.1016/j.ijsu.2014.06.011

来源: Elsevier

【 摘 要 】

Introduction: Recent studies have shown that radical gastrectomy with extended lymphadenectomy is feasible in gastric cancer patients with liver cirrhosis, but in those studies the main proportion was Child-Pugh class A patients. It is still difficult to choose reasonable surgical strategies for gastric cancer patients with cirrhosis, especially for Child-Pugh class B patients. Methods: We reviewed the medical records of patients with liver cirrhosis who had undergone radical gastrectomy between January 2001 and December 2012. The clinical characteristics, postoperative complications, mortality and long-term outcomes in the 58 patients were investigated. Results: Severe complications and postoperative mortality occurred more frequently in class B patients than in class A patients (P < 0.05). In patients with class A and B, the complications and mortality rate was 37.5% and 4.2% in D1 lymph node dissection group and 71.9% and 25% in D2 lymph node dissection group, respectively. Kaplan-Meier survival analysis showed longer survival for class A patients than for class B patients (P < 0.05). For class B patients with advanced gastric cancer, D2 lymph node dissection could not provide a longer survival than D1 lymph node dissection (P = 0.282). Conclusion: Radical operation with D1 or D2 lymph node dissection can be tolerated in class A gastric cancer patients. D1 lymph node dissection is recommended in class B patients, and radical gastrectomy is very dangerous, even fatal for class C patients. (C) 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

【 授权许可】

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