内容紹介
Outcomes after Gastrojejunostomy for Unresectable Gastric Cancer(Including Two Cases of Conversion Surgery)―A Retrospective Study
Summary
Background: Gastrojejunostomy as palliative surgery has been thought to contribute towards resumption of food intake and improvement of the patient's quality of life. This study aimed to examine the effect of gastrojejunostomy for unresectable gastric cancer on mortality and postoperative course. Methods: We retrospectively examined the records of 34 patients who underwent gastrojejunostomy for unresectable gastric cancer in our hospital from April 2008 to November 2015. Characteristics of the patients and operations, postoperative courses, and overall survival were assessed. The Kaplan-Meier method and loglank test were used for the survival analysis. Results: The median overall survival was 310 days(95%CI: 136-485), and 1 year overall survival rate was 45%(95%CI: 27.5-61.1)in 34 patients who underwent gastrojejunostomy. Liver metastasis was associated with a lower survival rate, and chemotherapy after gastrojejunostomy was associated with a significantly higher survival rate. Two of 34 patients(5.9%)underwent conversion surgery after effective chemotherapy. Conclusion: Gastrojejunostomy for unresectable gastric cancer may have the potential to contribute towards not only an improvement in the patient's quality of life with regard to the resumption of food intake, but also prolongation of the overall survival with chemotherapy and conversion surgery.
要旨
目的: 切除不能進行胃癌に対して消化管バイパス手術を施行した症例について術後経過・生存期間の検討,生存期間に影響を与える臨床因子抽出を目的とし,さらに近年施行されているconversion surgery症例の検討を行った。方法: 当院で2008年4月～2015年11月に切除不能進行胃癌に対して消化管バイパス手術を施行した34例について後方視的に検討した。生存期間算出にはKaplan-Meier法,臨床因子の検定にはlogrank testを用いて解析を行った。結果: 消化管バイパス手術を施行した34例の生存期間中央値は310日(95%Cl: 136-485),1年生存率は45%(95%Cl: 27.5-61.1)であった。単変量解析では生存期間に影響を与える正/負の因子として,それぞれ化学療法導入と肝転移が抽出された。2/34例(5.9%)で術後化学療法が奏効し,conversion surgeryを施行した。結論: 切除不能進行胃癌に対する消化管バイパス手術は患者の経口摂取を再開しQOL向上に寄与するだけでなく,術後化学療法やconversion surgeryを組み合わせることで生存期間延長に寄与する可能性が期待される。
目次
Summary
Background: Gastrojejunostomy as palliative surgery has been thought to contribute towards resumption of food intake and improvement of the patient's quality of life. This study aimed to examine the effect of gastrojejunostomy for unresectable gastric cancer on mortality and postoperative course. Methods: We retrospectively examined the records of 34 patients who underwent gastrojejunostomy for unresectable gastric cancer in our hospital from April 2008 to November 2015. Characteristics of the patients and operations, postoperative courses, and overall survival were assessed. The Kaplan-Meier method and loglank test were used for the survival analysis. Results: The median overall survival was 310 days(95%CI: 136-485), and 1 year overall survival rate was 45%(95%CI: 27.5-61.1)in 34 patients who underwent gastrojejunostomy. Liver metastasis was associated with a lower survival rate, and chemotherapy after gastrojejunostomy was associated with a significantly higher survival rate. Two of 34 patients(5.9%)underwent conversion surgery after effective chemotherapy. Conclusion: Gastrojejunostomy for unresectable gastric cancer may have the potential to contribute towards not only an improvement in the patient's quality of life with regard to the resumption of food intake, but also prolongation of the overall survival with chemotherapy and conversion surgery.
要旨
目的: 切除不能進行胃癌に対して消化管バイパス手術を施行した症例について術後経過・生存期間の検討,生存期間に影響を与える臨床因子抽出を目的とし,さらに近年施行されているconversion surgery症例の検討を行った。方法: 当院で2008年4月～2015年11月に切除不能進行胃癌に対して消化管バイパス手術を施行した34例について後方視的に検討した。生存期間算出にはKaplan-Meier法,臨床因子の検定にはlogrank testを用いて解析を行った。結果: 消化管バイパス手術を施行した34例の生存期間中央値は310日(95%Cl: 136-485),1年生存率は45%(95%Cl: 27.5-61.1)であった。単変量解析では生存期間に影響を与える正/負の因子として,それぞれ化学療法導入と肝転移が抽出された。2/34例(5.9%)で術後化学療法が奏効し,conversion surgeryを施行した。結論: 切除不能進行胃癌に対する消化管バイパス手術は患者の経口摂取を再開しQOL向上に寄与するだけでなく,術後化学療法やconversion surgeryを組み合わせることで生存期間延長に寄与する可能性が期待される。