| Background: Gastric cancer, as the fourth leading cancer in the world, continues to pose amajor challenge for the medical community. Gastric cancer is often diagnosed at advancedstage. As such, its mortality is largely contributed to disease relapses due to regional ordistant metastases. Though there have been increasing progresses in treatment means ofgastric cancer, its treatment mode has already been evolved into the comprehensivetreatment mode featuring united and standardized operation and perioperative adjuvanttherapy based on anatomy, oncobiology and immunology. Along with the improvement ofoperation technology, progress in comprehensive treatment method and early diagnosiscapacity, there has been great increase in overall survival in gastric cancer. However, theoperative treatment is still the basis of gastric cancer treatment. Standardized, rationalizedand radical operation of gastric cancer is still critical to increasing the lifetime of patientswith gastric cancer.Seen from the development history of medicine, operation is the first availablemethod for treatment of cancer. In1809, Ephraim McDowell incised a tumor ovariiwithout anesthesia, thus providing the evidence that the tumor goitre can be cured throughoperation. Billroth completed the first gastrectomy with success in1881while Schlatercompleted the first total gastrectomy successfully in1897. More than5decades from thenon, the surgical treatment of gastric cancer was basically just limited to subtotalgastrectomy level. After in1950s, the Japanese scholars raised gastrectomy and lymphnode dissection as well as the standard gastrectomy featuring the radical objective ofexcising over2/3of the stomach and second time lymph excision. Meanwhile, they alsostarted united excision of involved internal organs of the body and successively raisedstandard radical operation of gastric cancer D2and D3operation. Nevertheless, rationalexcision range of radical operation of gastric cancer has always been a controversial topic.The medical workers in different countries and regions hold different opinions. In theAsian countries, especially in China and Japan featuring high-occurrence of gastric cancer,the selection of lymph node dissection range in radical operation of gastric cancer wasmore radical with inclination to expanded lymph node dissection. However, the westerncountries were relatively conservative. Recently, radical operation II (D2) of lymph nodedissection has become the standard for lymph node dissection way for radical operation ofgastric cancer. Nevertheless, there is still no final conclusion about whether excision ofcapsula pancreatis and transverse mesocolon in radical operation D2of gastric cancer. For instance, the experts of Memorial Sloan-Kettering Cancer Center, advocated excision ofanterior lobe of transverse mesocolon and pancrease diolame, but the experts of MayoClinic and M.D. Anderson Cancer Center assumed that there was no clinical significancein excision of anterior lobe of transverse mesocolon and pancrease diolame, which was notexcised generally.Methods:Between January2007and July2008, a total of236patients were enrolled in thestudy. These patients were randomized to two treatment groups: group R and group N. Ingroup R, resection of PCFLTM was performed in D2dissection during radical gastrectomy.In group N, no PCFLTM resection was performed. Evidence of metastasis washistologically analyzed in resected PCFLTM specimen. In addition, operation time,hemorrhage loss during operation, number of dissected lymph nodes, postoperativecomplications,5-year survival rate were monitored in both groups. Apply χ2and t inspectionfor clinical data of N and R groups; apply Kaplan-Meier for calculation of postoperation survival rate;apply Log-rank rank test for comparison of survival rates in two groups; apply SPSS18.0statisticalsoftware and two-sided test for all data; α=0.05refers to the inspection level. There is statisticalsignificance when P<0.05.Results:No significant differences were found in operation time, hemorrhage loss duringoperation, postoperative complications and5-year survival rate between the two treatmentgroups. Metastases to PCFLTM were found in nine (8.57%) patients. Metastases topancreatic capsule and/or front leaf of transverse mesocolon were correlated to depth oftumor cell penetration, clinical staging, and perigastric lymph nodes metastasis (P<0.05).No correlation between the metastases and age, gender, tumor location, size, Borrmanntype, pathological classification or5-year survival rate was found (P＞0.05).Conclusion:As compared with group N, the resection of PCFLTM in group R did notincrease5-year survival rate. In certain patients with gastric cancer, resection of PCFLTMmay be considered unnecessary. |
PDF Full Text Request