JAMA Surg: 手术联合术中腹腔灌洗与单独手术治疗局部晚期胃癌的效果比较

2019-08-11 不详 MedSci原创

腹膜转移是胃癌患者术后复发的最常见模式。术中腹腔灌洗(EIPL)是治疗局部晚期胃癌腹膜转移的新型预防策略; 然而,EIPL的安全性和有效性目前尚不清楚。因此,本项研究旨在评估接受手术联合EIPL或单纯手术治疗的晚期胃癌的效果差异。

背景及目的:
腹膜转移是癌患者术后复发的最常见模式。术中腹腔灌洗(EIPL)是治疗局部晚期癌腹膜转移的新型预防策略; 然而,EIPL的安全性和有效性目前尚不清楚。因此,本项研究旨在评估接受手术联合EIPL或单纯手术治疗的晚期胃癌的效果差异。

方法:
研究人员收集了2016年3月至2017年11月共662名接受D2胃切除术的晚期胃癌患者的临床数据。共有329名患者被随机分配接受单独手术,333名患者被随机分配接受手术联合EIPL治疗。在意向治疗人群中比较两组的临床特征,手术结果和术后短期结果。主要观察结局是短期术后并发症和死亡率。

结果:
本项研究共纳入390名男性和160名女性的数据,单独手术组的平均(SD)年龄为60.8(10.7)岁,手术联合EIPL治疗组的平均(SD)年龄为60.6(10.8)岁。分配到手术联合EIPL治疗组的患者死亡率降低(279名患者中没有死亡),仅接受单独手术的患者则有5名死亡(P=.02)。单独接受手术的患者(46例[17.0%])和接受手术联合EIPL治疗的患者(31例[11.1%])的总体术后并发症发生率存在显着差异(差异,5.9%; 95%CI,0.1%-11.6%; P= .04)。仅手术后[17.7%]患者术后疼痛发生率高于术后加EIPL[10.8%](差异,7.0%; 95%CI,0.8%-13.1%; P=.02) 。

结论:
手术联合EIPL可以提高D2胃切除术的安全性,减少术后短期并发症和伤口疼痛。本项研究表明,晚期胃癌患者似乎是EIPL方法的合适者。

原始出处:

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    2019-08-13 chg122
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    2019-08-11 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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    2019-08-11 1ddf0692m34(暂无匿称)

    学习了,谢谢分享

    0

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