| 위암과 비장절제 |
| 김성철, 김선회, 배성한, 박재갑, 김진복 |
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| The Effect of Splenectomy on the Prognosis of Gastric Cancer |
| Seong Chul Kim, Sun Whe Kim, Sung Han Bae, Jae Gahb Park, Jin Pok Kim |
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| ABSTRACT |
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1n the surgery of gastric cancer, combined splenectomy has been advocated in order to enhance the radical nature of the operation. In some cases, splenectomy is done due to incidental injury of the spleen during the operation. There may be micrometastasis of gastric cancer to the lymph node of the splenic hilum or the splenic artery. When gastrectomy with combined splenectomy be performed for gastric cancer, though it can remove the micrometastasis to ihe lymph node of the splenic hilum or splenic artery, postsplenectomy change will affect the body. In order to examine the effect of splenectomy-incidental or as a part of curative resection-on the postoperative course of the gastric cancer patients, we studied the cases of gastrectomy with splenectomy for stage II and stage III gastric cancer, and compared with those of gastrectomy without splenectomy for the same stage. The results were as follows; from 1970 to 1986, the number of cases of gastrectomy with splenectomy for stage II and stage III gastric cancer was 90, among which retrospective study was possible in 74 cases; stage II 25cases, stage III 49 cases. 1) The cumulative survival rates of gastrectomy with splenectomy group in stage II gastric cancer were 1 year 96.0%, 2 year 84.0%, 3 year 79.8%, 4 year 74.8%, and 5 year 69.0%-100%, 85.7%, 85.7%, 76.1%, 76.1% in radical subtotal gastrectomy with splenectomy group and 90.1%, 81.8%, 72.7%, 72.7 %, 62.3% in total gastrectomy with splenectomy group, respectively. In stage III gsstric cancer, gastrectomy with splenectomy showed that 1, 2, 3, 4 and 5 year survival rates were 89.8%, 46.9%, 23.5%, 17.1%, and 17.1%, respectively -88.0%, 36,0%, 20.0%, 16.09o, and 16. 0% in radical subtotal gastrectorny with splenectomy group and 91.7%, 58.3%, 26.9%, 17.9 %, and 17. 9% in total gastrectomy with splenectomy group. 2) The splenectomy had the negative effect on the stage III gastric cancer (p < 0.001, Log-rank test). The negative effect on the subtotal gastrectomy for stage Ill gastric cancer was statistically significant (p < 0.010) but not on the total gastrectomy for stage III gastric cancer. 3) The portion of lymphocytes to the white blood cells and the number of platelets per cubic millimeter increased postoperatively in the group surviving more than 3 years, which is consistent with the postsplenectomy change, but not in the patients who could not survive 3 years after operation. 4) The postoperative complications developed in 8 cases-pfeural effusion in 4 cases, LUQ abscess in 2 cases, fever, unknown origin in 1 case, and meningitis in 1 case. |
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