目的:关于胃癌穿孔(PGC)的治疗尚无科学共识。因此,这项研究的目的是探讨在单阶段和两阶段策略之间,哪种治疗PGC的方案更好.
方法:对来自13家医疗机构的81例PGC患者进行回顾性研究。将接受R0胃切除术的PGC患者分为一期手术组和二期手术组。比较两组患者的临床病理特征,随机选择415例无穿孔的常规胃癌患者作为对照。使用倾向评分匹配(PSM)方法来寻找具有相似临床病理参数的匹配的常规GC患者。比较了PGC患者和常规GC患者的OS(总生存期)和收集的淋巴结数量。
结果:与接受一期手术的PGC患者相比,那些接受了两阶段手术的人收获了更多的淋巴结[31(27,38)vs17(12,24),P<0.001],需要更少的输血[0(0,100)和200(0,800),P=0.034],ICU住院时间较短[0(0,1.5)vs3(0,3),P=0.009],并有明显更好的操作系统(操作系统中位数:45个月比11个月,P=0.007)。与倾向评分匹配的无穿孔的常规GC患者相比,接受一期胃切除术的PGC患者的淋巴结清扫质量较差[17(12,24)vs29(21,37),P<0.001],OS更差(OS中位数:18个月vs30个月,P=0.024)。相反,与倾向评分匹配的常规GC患者相比,两阶段胃切除术可实现相当的淋巴结清扫质量(P=0.506)和相似的OS(P=0.096).
结论:对于病情较差的PGC患者,当急诊手术无法实现D2根治术时,两阶段治疗是更好的选择,根据我们的发现,两阶段胃切除术可以为PGC患者提供更好的淋巴结清扫质量和更好的OS。
OBJECTIVE: There is no scientific consensus about the treatment of perforated gastric cancer (PGC). Therefore, the aim of this
study was to investigate which is the better treatment option for PGC between the single-stage and two-stage strategies.
METHODS: All 81 PGC patients from 13 medical institutions were retrospectively enrolled in this
study. The PGC patients who underwent R0 gastrectomy were divided into one-stage surgery and two-stage surgery groups. The clinicopathological characteristics of the two groups were compared, and 415 regular gastric cancer patients without perforation were randomly selected as a control. The propensity score matching (PSM) method was used to find matched regular GC patients with similar clinicopathological parameters. The OS (overall survival) and the number harvested lymph nodes from PGC patients and regular GC patients were compared.
RESULTS: Compared with PGC patients who underwent one-stage surgery, those who underwent two-stage surgery harvested significantly more lymph nodes [31(27, 38) vs 17 (12, 24), P < 0.001], required less blood transfusion [0 (0, 100) vs 200 (0, 800), P = 0.034], had a shorter ICU stay [0 (0, 1.5) vs 3 (0, 3), P = 0.009], and had a significantly better OS (Median OS: 45 months vs 11 months, P = 0.007). Compared with propensity score-matched regular GC patients without perforation, PGC patients who underwent one-stage gastrectomy had a poorer quality of lymphadenectomy [17 (12, 24) vs 29 (21, 37), P < 0.001] and suffered a worse OS (Median OS: 18 months vs 30 months, P = 0.024). Conversely, two-stage gastrectomy can achieve a comparable quality of lymphadenectomy (P = 0.506) and a similar OS (P = 0.096) compared to propensity score-matched regular GC patients.
CONCLUSIONS: For PGC patients in poor condition, two-stage treatment is a better option when D2 radical gastrectomy cannot be achieved in emergency surgery, based on our findings that two-stage gastrectomy could provide PGC patients with a better quality of lymphadenectomy and a better OS.