Systematische Lymphadenektomie beim Magenkarzinom -Prognoseverbesserung oder Risikoerhöhung ?
| Autor: | S. Braunstein, M. Imhof, J. W. Heise, H. D. Röher, N. M. Bösing |
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| Rok vydání: | 2007 |
| Předmět: | |
| Zdroj: | Viszeralchirurgie. 42:27-34 |
| ISSN: | 1439-1643 1435-3067 |
| DOI: | 10.1055/s-2007-958714 |
| Popis: | D2-LYMPHADENECTOMY IN GASTRIC CANCER: PROGNOSTIC BENEFIT OR INCREASED PERIOPERATIVE RISK? The discussion about prognostic relevance and perioperative morbidity and mortality in gastric cancer surgery caused by systematic lymphadenectomy (D 2 -dissection) is still controversial. The impact of D 2 - and D 1 -dissection on long term survival and perioperative morbidity and mortality was evaluated analysing prospectively documentated data of 281 R 0 -resected gastric cancer patients (time period: 1986-2000; sex ratio: m:f=2:1; mean age: 64 years). Perioperative morbidity (36% vs 38%) and hospital mortality (4% vs 5%) did not differ significantly between D 2 - and D 1 -dissection groups. In contrast, perioperative morbidity increased significantly in multivisceral surgery from 30% to 45% (p=0.008) and perioperative mortality was doubled (3% vs 6%; p=0.293). D 2 -dissection was carried out in 143 patients and 138 patients were treated with D 1 -dis-section. Comparing all 281 R 0 -resected patients we did not find significant differences in 5-year survival (49% vs 43% p=0.283) between both groups. In subgroup analysis patients with pTX pN2/3 tumor stages (n=74) did not significantly benefit from D 2 -dissection (5 year survival: 16% vs 5%; p=0.249). However, the 207 patients with pTXpN0/1 tumor stages demonstrated a signi-ficantly better 5 year survival rate following D 2 -dissection (68% vs 50%; p=0.003). Especially patients younger than 65 years of age (n=96) with pTXpN0/1 tumor stages took advantage from D 2 -dissection. The 5 year survival was 84% in 49 D 2 - and 57% in 47 D 1 -dissections (p |
| Databáze: | OpenAIRE |
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