Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지

A Comparison of Segmental Gastrectomy and Distal Gastrectomy with Billroth I Reconstruction for Early Gastric Cancer That's Developed on the Gastric Body

위체부에 발생한 조기위암에서 위구획절제술과 Billroth I 재건술식의 비교

  • Song, Min-Sang (Department of Surgery, Chungnam National University School of Medicine) ;
  • Lee, Sang-Il (Department of Surgery, Chungnam National University School of Medicine) ;
  • Sul, Ji-Young (Department of Surgery, Chungnam National University School of Medicine) ;
  • Noh, Seung-Moo (Department of Surgery, Chungnam National University School of Medicine)
  • 송민상 (충남대학교 의학전문대학원 외과학교실) ;
  • 이상일 (충남대학교 의학전문대학원 외과학교실) ;
  • 설지영 (충남대학교 의학전문대학원 외과학교실) ;
  • 노승무 (충남대학교 의학전문대학원 외과학교실)
  • Received : 2009.06.30
  • Accepted : 2009.10.30
  • Published : 2009.12.30
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Abstract

Purpose: Subtotal distal gastrectomy has been accepted as the standard treatment for early gastric cancer that's developed on the gastric body. EMR and ESD have been introduced to minimize the incidence of postgastrectomy syndrome, but these procedures can not detect lymph node metastasis and they have a risk for gastric perforation. Segmental gastrectomy has recently been applied for treating early gastric cancer, but its usefulness has not been clarified. The aim of this study was to compare segmental gastrectomy and distal gastrectomy with Billroth I reconstruction for treating early gastric cancer that's developed on the gastric body. Materials and Methods: We performed a retrospective review of all the patients who were diagnosed as having early gastric cancer that developed on the gastric body at Chungnam National University Hospital from January 2004 through July 2007. During this period, 41 patients received segmental gastrectomy and 40 patients underwent subtotal distal gastrectomy. All the patients were studied via a biannual review of the body systems, a physical examination, endoscopy, computed tomography and the laboratory findings. Results: There were no significantly differences of the clinicopathologic characteristics between the two groups. The changes of the nutritional status (Hb, TP, Alb and TC) and the body weight change were not significantly different between the 2 groups. There were significantly more residual food in the SG group than that in the SDG group (RGB classification, Residual>Grade 2), but there were no differences for epigastric discomfort (P>0.05). Esophagitis developed at a similar rate for both two groups (LA classification, >Grade A), and bile reflux was found in only one patient of each group. Conclusion: We expected the reduction of esophagitis and gastritis and the improvement of nutritional status according to the type of procedure. Yet the results of our study showed no significant differences between the two study groups. More patients and a longer follow up time are needed for determining the advantage sand disadvantages of segmental gastrectomy.

목적: 위체부에 발생하는 조기위암에 대해 원위부 위아전 절제술(SDG)이 표준 술식으로 시행되나 술 후 기능장애와 합병증이 있으며, 이런 단점을 최소화하기 위해 내시경적점막절제술을 하지만 림프절의 전이여부를 알 수 없는 단점이 있다. 위의 절제 범위를 줄이고 유문을 보존하고, 림프절의 절제가 가능한 위구획절제술(SG)에 대해 그 유용성을 평가하고자 한다. 대상 및 방법: 2004년 1월부터 2007년 7월까지 본원에서 위체부의 조기위암 환자 중 41명에서 SG를 하였고, 40명에서는 SDG를 하였다. 의무기록 및 전화를 이용한 설문을 이용하여 수술 후 6개월과 12개월의 영양상태와 술 후 합병증에 대해 두 군을 비교하였다. 결과: 영양상태의 변화(혈색소, 혈장단백, 혈장알부민, 혈장콜레스테롤, P>0.05)와 체중의 변화에서 유의한 차이는 보이지 않았다. SG군에서 SDG군에 비하여 내시경 시 잔여음식물(P<0.05)이 많았으나, 상복부 불편감이나 식사 시조기 팽만감에는 큰 차이가 없었다(P>0.05). 식도염은 두군에서 비슷한 발생률을 보였고(P>0.05), 담즙 역류는 SG군과 SDG군에서 각 한 명만 관찰이 되었다. 결론: SG군에서는 유문이 보존되므로 담즙 역류로 인한식도염, 위염의 발생 감소와, 위절제범위의 감소와 유문보존으로 인한 영양학적인 장점을 기대하였으나, 현재까지의 결과는 두 군에서 큰 차이를 발견할 수 없었다. SG의 장점과 단점을 알기 위해서는 더 오랜 기간의 경과관찰과 연구가 필요할 것으로 생각한다.

Keywords

References

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