Author/Editor		Jagrič, Tomaž; Ivanecz, Arpad; Hazabent, Marko; Potrč, Stojan
Title		Ali je proksimalna subtotalna gastrektomija z interponatom pri izbranih pacientih boljši poseg kot totalna gastrektomija
Translated title		Proximal or total gastrectomy regarding the quality of life in patients with carcinoma of the cardia
Type		članek
Source		In: Potrč S, Hazabent M, Gajzer B, editors. 2. Mariborski onkološki dan: simpozij z mednarodno udeležbo na temo Maligna obolenja želodca; 2009 nov 27; Maribor. Maribor: Oddelek za abdominalno in splošno kirurgijo, Kirurška klinika UKC,
Publication year		2009
Volume		str. 209-23
Language		slo
Abstract		Background and aim: The proximal resection with modified D2 lymphadenectomy is gradually being accepted as the therapy of choice for early stage adenocarcinomas of the gastric cardia. It restores the function of the organ, prevents or decreases the number of complications associated with the operation for one, and complies with modern oncological principles on the other side. The aim of our study was to evaluate the proximal resection with modified D2 limfadenectomy as an alternative in selected patients. Methods: Between the years 1993 and 2009 161 patients was operated in our centre for adenocarcinoma of the proximal third of the stomach. They were divided into three groups: i) PG: proximal subtotal resection with interponate and modified D2 lymphadenectomy (19,3%, 31 patients); ii) TH: transhiatal extended total gastrectomy with resection of the distal esophagus and D2 lymphadenectomy (23,6%, 38 patients); iii) GT: total gastrectomy with D2 lymphadenectomy (57,1%, 92 patients). We analyzed the postoperative morbidity,30 day mortality and survival. The quality of life was evaluated with GIQLI (gastro-intestinal quality of life index) questionnaire. Results: the patients in PG group were with 79,4 9 years significantly older as the patients in GT (63,9 11 years) or TH group (60,1 12 years) (p<0,0001) and in worse general condition. The number of harvested lymph nodes (LN) (17,2 11 LN) was significantly smaller than in GT and TH groups (24,5 13 and 26,3 13LN). There were no significant differences in the distribution of pathohystological characteristics and TNM stages of the tumors between groups.In all groups the R0 resection could be accomplished in 77,2% to 86,8% of cases (p=0,096). The 30 day mortality was 6,5% in GT, 9,7% in PG and 5,3% in TH group. There were no differences in the morbidity and 5-year survival between groups (26,3% in GT, 28,9% in TH and 25,3% in PG group). (Abs. trunc. at 2000 ch.)
Summary		Izhodišča: Za zgodnje stadije adenokarcinomov kardije se vse bolj uveljavlja princip proksimalne resekcije in modificirane D2 limfadenektomije, ki poizkušav največji možni meri ohraniti funkcijo, preprečiti ali zmanjšati zaplete, hkrati pa zadostovati sodobnim onkološkim principom. Cilj študije je bil potrditi upravičenost proksimalne gastrektomije z interponatom kot alternativo pri izbranih pacientih. Metode: Med letoma 1993 in 2009 je bilo nanašem centru operiranih 161 pacientov s karcinomom zgornje tretjine želodca,ki smo jih razdelili v tri skupine: i) PG: proksimalna subtotalna resekcija z interponatom in omejeno D2 limfadenektomijo (19,3%, 31 bolnikov); ii) TH: transhiatalno razširjena totalna gastrektomija z resekcijo distalnega dela požiralnika in D2 limfadenektomijo (23,6%, 38 bolnikov); iii) GT: totalna gastrektomija z D2 limfadenektomijo (57,1%, 92 bolnikov). Zanimali so nas pooperativni poteki z zapleti, ki smo jih delili na kirurške in splošne, 30 dnevna pooperativna smrtnost in preživetje v posameznih skupinah, kvalitetoživljenja, pa smo ocenjevali s prirejenim GIQLI (gastro-intestinal quality of life index) vprašalnikom. Rezultati: V PG skupini so bili s 70,4 9 leti bistveno starejši pacienti od ostalih dveh skupin (GT: 63,9 11 let; TH: 60,1 12 let) (p<0,0001), hkrati, pa so bili v slabšem splošnem stanju. V skupini PG (17,2 11 bezgavk) je bilo odvzetih bistveno manj bezgavk kot v skupinah GT in TH (24,5 13 in 26,3 13 bezgavk). Med skupinami nismo opazili razlik med patohistološkimi značilnostmi karcinomov in porazdelitvi TNM stadijev. V vseh treh skupinah je bilo mogoče doseči R0 resekcijo v 77,2% do 86,8% primerov (p=0,096). 30 dnevna mortaliteta po skupinah je bila 6,5% v GT skupini, 9,7% v PG skupini in 5,3% v TH skupini. Bolniki se po številu zapletov niso bistveno razlikovali, prav tako nismo opazili razlik v 5 letnem preživetju (26,3% v GT, 28,9% v TH in 25,3% v PG skupini). (Izvl. skrajšan na 2000 zn.)
Descriptors		STOMACH NEOPLASMS GASTRECTOMY QUALITY OF LIFE