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開催概要
開催回
第56回・2018年・横浜
 

症状を有するStageIV胃がんの初期治療はバイパスか胃切除か

演題番号 : P9-4

[筆頭演者]
演者)加野 将之:1 
[共同演者]
早野 康一:1、村上 健太郎:1、上里 昌也:1、豊住 武司:1、林 秀樹:1、坂田 治人:1、松原 久裕:1

1:千葉大学・先端応用外科

 

Gastrectomy has not been justified for the treatment of asymptomatic gastric cancer patients with non-curative factors. Is there the indication of gastric resection for symptomatic (ex. Gastric stricture or bleeding) patients of StageIV gastric cancer? In Gastric Cancer Treatment Guideline, palliative gastric resection is the clinical choices if it is performed safely, and gastrojejunostomy is selected if gastric resection is hard to perform or keep safety. 167 StageIV gastric cancer patients was examined retrospectively. Cases with more than one non-curative factor and symptoms occurred with the gastric tumor are included. Cases with T4b of tumor depth and only CY1P0 as non-curative factor are excluded. 67 cases are examined in detail. Group A: Initially gastrojejunostomy was performed(n=37). Group B: Initially gastric resection was performed(n=30). Median survival time (MST) is 14/ 11 months respectively (p=p.870 log-rank test). Conversion Surgery are performed for 6 patients (16.2%) of Group A, and MST is 23 months, which is statistically no change rather than the other patients (p=0.073) but good prognosis. Initially gastrojejunostomy procedure could be selected for symptomatic StageIV gastric cancer patients as daily practice. However, there are a few cases with over 5-year survival only in patients after initially gastric resection, which could have an indication for the limited patients. That is next agenda. The development of first line chemotherapy including immune checkpoint inhibitors and existing second line chemotherapy, which is more than 50% response rate, though there exist phase II trials, are worthy of the attention. Authors herein reports with considerations with the literatures.

キーワード

臓器別:胃・十二指腸

手法別:手術療法

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