Author/Editor		Potrč, Stojan; Kavalar, Rajko; Hajdinjak, Tine; Horvat, Matjaž; Vidovič, Damjan; Šturm, Maja; Ivanecz, Arpad; Gadžijev, Eldar
Title		Kaj smo se naučili pri kirurškem zdravljenju adenokarcinoma želodca: primerjava dveh obdobij
Translated title		What did we learn in surgical treatment of gastric adenocarcinoma: compariosn of two periods
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. 4
Publication year		2004
Volume		str. 249-53
Language		slo
Abstract		Background. In January 1992 a standardized and more radical surgical approach in gastric cancer treatment as well as standardized pathohistological workup of specimens was started in our institution. The aim of our retrospectively designed study was to evaluate results of this work for the 10 year period. Methods. We compared the results of two chronologically subsequent groups of altogether 402 patients who underwent a total or subtotal gastrectomy for gastric cancer (period A: 166 patients operated in a period between 1992 and 1996; period B: 236 patients operated in a period between 1997 and 2001). Results. The two groups of patients were comparable with regard to age, gender, general condition of the patient and proportion of potentially curable (R0) resections. There was significant difference between the groups with regard to type of operation (more total gastrectomies in period B), extend of lymphadenectomy (more D2 and D3 in period B), average number of examined nodes (higher in period B) and to the UICC stage (less stage II in period B). Incidence of surgical complications (15.6% vs. 18.7%) and average hospital stay were not significantly different between the two groups (14.72 days vs. 14.70 days). The 5-year survival calculated according to Kaplan Meier for all patients with R0 and R2 resections together was 30.3% and was 39.1% for the group of R0 resected patients. In patients with UICC stage I-Illa and R0 resection the 5-year survival was significantly higher in period B (59.9%) than in period A (40.6%) (p = 0.0197). Conclusions. Comparison of two chronologically subsequent groups of patients shows that after a definite period of systematical surgical work improvements of results set in, and are reflecting in the present study in higher number of extracted lymph nodes, in higher number of total gastrectomies and in higher 5 year survival for stages la, Ib, II and Illa in the period B.
Summary		Izhodišča. V januarju 1992 smo uvedli standardiziran in radikalnejši pristop v kirurškem zdravljenju raka želodca skupaj s standardizirano patohistološko obravnavo. Namen naše študije je preučiti uvajanje in rezultate takega pristopa za obdobje 10 let. Metode. 402 bolnika, ki so imeli napravljeno resekcijo želodca zaradi raka želodca med letoma 1992 in 2001, smo razdelili v dve kronološko zaporedni obdobji: obdobje A - 166 bolnikov, operiranih od 1992 do 1996 in obdobje B - 236 bolnikov, operiranih od 1997 do 2001. Primerjali smo značilnosti tumorjev, operativne pristope in zaplete zdravljenja med skupinami ter ugotavljali, kateri dejavniki vplivajo na dolžino preživetja. Rezultati. Bolniki v obeh obdobjih se niso razlikovali po spolu, starosti, splošnem stanju (ASA) in deležu R0 resekcij. Razlike smo našli v tipu operacije (v obdobju B večji delež totalnih gastrektomij), obsegu limfadenektomije (v obdobju B več D2 in D3 limfadenektomiji, povprečnem številu z boleznijo zajetih bezgavk ter povprečnem številu bezgavk, zajetih v preparatu (več v obdobju B). Zaradi nepopolne patohistološke obravnave ni bilo moč razvrstiti 19 bolnikov (manj v obdobju B). Delež kirurških zapletov (15,6% proti 18,7%) in povprečna ležalna doba (14,72 proti 14,70 dneva) se niso statistično značilno razlikovali med obdobjema. 5-letno preživetje, izračunano po metodi Kaplan-Meier za vso skupino bolnikov po R0 in R2 resekcijah skupaj je znašalo 30,3%, po R0 resekciji pa 39,1%. Pri bolnikih z UICC stadijem I-IIIa je bilo izračunano petletno preživetje po R0 resekciji statistično značilno višje v obdobju B (59,9%) v primerjavi z obdobjem A (40,6%) (p = 0,0197). Zaključki. Primerjava dveh kronološko zaporednih skupin bolnikov kaže, da se šele po določenem obdobju sistematičnega in poglobljenega kirurškega dela začno izboljševati rezultati. (Izvleček skrajšan pri 2000 znakih).
Descriptors		STOMACH NEOPLASMS ADENOCARCINOMA LYMPH NODE EXCISION LYMPHATIC METASTASIS NEOPLASM STAGING POSTOPERATIVE COMPLICATIONS GASTRECTOMY LENGTH OF STAY SURVIVAL ANALYSIS