비장절제술을 동반하는 위암의 수술방법들에 대한 임상적 고찰
Review of Splenectomy, Pancreas-preserving Splenectomy, Pancreatosplenectomy for Combined Radical Total Gastrectomy
민근식, 차진우, 김명욱, 조용관, 한상욱, 김지훈,
소속 상세정보
민근식 ( Min Gun-Sik )
아주대학교 의과대학 외과학교실
차진우 ( Cha Jin-Woo )
아주대학교 의과대학 외과학교실
김명욱 ( Kim Myung-Wook )
아주대학교 의과대학 외과학교실
조용관 ( Cho Yong-Kwan )
아주대학교 의과대학 외과학교실
한상욱 ( Han Sang-Uk )
아주대학교 의과대학 외과학교실
김지훈 ( Kim Ji-Hun )
아주대학교 의과대학 외과학교실
KMID : 0371320020630050397
Abstract
Purpose: Splenectomy, pancreas-preserving splenectomy, pancreato-splenectomy are common combined operations of a total gastrectomy for gastric cancer. We attempted to determine the efficacy of these procedures after comparing and analyzing
the
complication rate and the five-year survival rate from the gastric cancer patients.
Methods: 121 advanced gastric cancer patients, except T4 patients, underwent radical total gastrectomy accompanied with splenectomy. and analyzed the clinical findings eg. age, sex, location of tumor, histological differentiation, lymph
node
metastasis, number of dissected LN, complication and the 5-year survival rate.
Results: 44 out of 121 patients underwent a pancreato-splencetomy, 53 patients underwent a pancreas-preserving splenectomy, and 24 patients underwent a simple splenectomy. There were no statistical difference in the patient’s age, sex,
location
of tumor, histological differentiation, lymph node metastasis, the number of dissected LN and the 5 year-survival rate in stage Ⅱ, Ⅳ with each operation. However, a pancreas-preserving splenectomy showed a better 5-year survival rate (53.7%) than
a
simple splenectomy (25.0%) and pancreato-splenectomy (32.1%) in stage Ⅲ. The complication rate was 25% in a simple splenectomy, 17% in a pancreas-preserving splenectomy, 30% in a pancreato-splenectomy. Diabetes mellitus occurred in 3 patients
who
underwent a pancreato-splenectomy, in 1 patient with an iatrogenic splenic vein excision during a pancreas-preserving splenectomy.
Conclusion: A pancreas-preserving splenectomy is the best choice in stage IIIa total gastrectomy patients with the lowest complication rate.
키워드
위암; 위전절제술; 췌장보존식 비장절제술; 췌비장절제술; Gastric cancer; Total gastrectomy; Pancreas-preserving splenectomy;
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