Lokal ileri mide kanserlerinde en-blok multiorgan rezeksiyonu yapılan hastaların erken ve geç dönem sonuçları ve bu sonuçlara etki eden faktörler

Year 2023, Volume: 22 Issue: 2, 77 - 84, 31.08.2023

Osman Aydın Yiğit Mehmet Özgün Volkan Öter Muhammet Kadri Çolakoğlu Erol Pişkin Erdem Kakil Gökhan Uçar Erdal Birol Bostancı

https://doi.org/10.17941/agd.1336914

Abstract

Giriş ve Amaç: Bu çalışmanın amacı, yüksek volümlü bir merkezde lokal ileri mide kanseri nedeniyle opere edilen komşu organ invazyonu (cT4b) olan hastaların erken ve geç sonuçlarını incelemek ve sağkalımı etkileyen faktörleri araştırmaktır. Gereç ve Yöntem: 2015-2019 yılları arasında lokal ileri mide kanseri nedeniyle gastrektomi ve en-blok komşu organ rezeksiyonu yapılan hastalar çalışmaya dahil edildi. Bulgular: Klinik T4b tümörü nedeniyle mide kanseri nedeniyle ameliyat edilen 435 hastanın 54'üne radikal gastrektomi ve en-blok ek organ rezeksiyonu uygulandı. Tüm hastaların yaş ortalaması 61.87 ± 12.67 idi. Ortanca sağkalım 16.5 (1 - 72) ay olarak bulundu. 37 (%68.5) hastada birinci yıl sağkalım, 11 (%20.3) hastada üç yıllık sağkalım ve sadece 4 (%7.4) hastada beş yıllık sağkalım sağlandı. Uzun dönem sağkalımı etkileyen faktörlere bakıldığında postoperatif komplikasyonların sağkalımı anlamlı olarak etkilediği görüldü (p = 0.04). R1 rezeksiyon (p = 0.001), büyük tümör çapı (p = 0.02), lenfovasküler invazyon (p = 0.024) ve perinöral invazyon (p = 0.024) varlığının uzun dönem sağkalımı olumsuz etkilediğini bulduk. Sonuç: Klinik T4b mide kanserli hastalarda yeterli lenf nodu diseksiyonu ve komşu organla en-blok R0 rezeksiyonu uzun dönem sağkalım için önemlidir. Tümörün T-evresi ne olursa olsun cerrahi yapılmalıdır. Bu açıdan yeterli R0 rezeksiyon ile yapılan cerrahi, sağkalımı etkileyen bağımsız bir prognostik faktör olarak değerlendirilebilir. Uzun süreli sağkalımı etkileyen diğer faktörler, lenf nodu metastazı, tümör boyutu, ameliyat sonrası komplikasyonlar ve vasküler ve perinöral invazyondur.

Keywords

Lokal ileri mide kanseri, en-blok multiorgan rezeksiyonu, sonuçlar

Early and late outcomes of patients who underwent en-bloc multiorgan resection in locally advanced gastric cancer and factors affecting the result

Abstract

Background and Aims: The aim of this study is to examine the early and late results of patients with adjacent organ invasion (cT4b) who were operated for locally advanced gastric cancer in a high-volume center and to investigate the factors affecting survival. Material and Methods: Patients who underwent gastrectomy and en-bloc adjacent organ resection due to locally advanced gastric cancer between 2015 and 2019 were included in the study. Results: Radical gastrectomy and en-bloc additional organ resection were performed in 54 patients out of 435 patients who were operated for gastric cancer due to clinical T4b tumors. The mean age of all patients was 61.87 ± 12.67years. The median survival was found to be 16.5 (1 - 72) months. First-year survival was achieved in 37 (68.5%) patients, three-year survival in 11 (20.3%) and five-year survival in only 4 (7.4%) patients. Considering the factors affecting long-term survival, it was seen that postoperative complications affected survival significantly (p = 0.04). We found that performing R1 resection (p = 0.001), large tumor diameter (p = 0.02), presence of lymphovascular invasion (p = 0.024) and presence of perineural invasion (p = 0.024) adversely affected long-term survival. Conclusion: Adequate lymph node dissection and en bloc R0 resection with adjacent organ are important for long-term survival in patients with clinical T4b gastric cancer. Surgery should be performed regardless of the T-stage of the tumor. In this respect, surgery performed with adequate R0 resection can be considered as an independent prognostic factor affecting survival. Other factors affecting long-term survival are lymph node metastasis, tumor size, post-operative complications, and vascular and perineural invasion.

Keywords

Locally advanced gastric cancer, en-bloc multiorgan resection, results

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