위암 환자의 위전절제술시 비장절제가 예후에 미치는 영향에 관한 연구
Effects of Combined Splenectomy with Total Gastrectomy on the Prognosis in Gastric Cancer
대한암학회지 1997년 29권 4호 p.632 ~ 639
소속 상세정보
목영재/Young Jae Mok
김승주/손길수/조민영/김영철/김세민/Seung Joo Kim/Gil Soo Son/Min Young Cho/Young Chul Kim/Sae Min Kim
KMID : 0360319970290040632
Abstract
결론
위전절제술을 받은 위암환자의 후향적 조사에서 비장절제술이 예후를 향상시키지 못하였
다. 그러나 비장절제 예는 비장비절제 예에 비해 위암의 크기 4 cm 이상, Borrmann III형,
육안적으로 T3, T4, 장막이상 침습암, UICC, TNM 병기 IIIb, IV에서 많음을 알 수 있었고
통계학적으로도 유의하였다. 또한 수술 후 합병증은 비장절제군에서 비장비절제군에 비해
3.3%가 높았으며 수술 후 5년 누적생존율은 비장절제군 51.1%에 비해 비장비절제군은
57.3%이었다. 이상과 같은 연구결과는 위전절제술 시 근치율을 높이기 위한 예방적 비장절
제에 대한 의문을 갖게 하였으며 치료효과의 판정이나 예후에 미치는 영향을 알기 위하여는
잘 계획된 전향적 연구가 필요하다.
#초록#
Purpose: This study was carried out to evaluate the impact of combined splenectomy
with total gastrectomy on survival and postoperative morbidity in advanced gastric
cancer.
Patients and Methods: We performed a retrospective analysis of 193 patients who
underwent curative resection among 289 patients with total gastrectomy during the
period of Sep. 1983 through Dec. 1995 at the Department of Surgery, Korea University
Hospital.
Results: Out of 11 clinicopathologic factors, 5 were associated with splenectomy
through univariate analysis. The incidence of splenectomy increased when the patients
with advanced gastric cancer had Borrmann type III, Gross T3 & T4 stage, greater than
4 cm of tumor size, Serosal invasion, or UICC stage IIIb, IV(p<0.05). Postoperative
complication occurred more commonly in splenectomy group than in non-splenectomy
group(20.2% vs 16.9%). The 5-year survival rate of Stage II was lower in splenectomy
group than in non-splenectomy group(63.5% vs 83.5%) but that of Stage III was higher
in splenectomy group than in non-splenectomy group(22.8% vs 17.3%), there was no
significant difference between the survival rates across different stages.
Conclusion: We could not find any beneficial effect of splenectomy in gastric cancer
patients who underwent curative total gastrectomy in this retrospective analysis. There
was no clinical evidence to support splenectomy as a general policy in patients with
total gastrectomy. We conclude that the randomized prospective clinical trials using more
precise criteria for the indication of splenectomy are needed in order to assess the
beneficial effect of splenectomy.
키워드
Gastric cancer; Splenectomy; Prognosis;
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