Journal of Gastric Cancer

  • 제9권4호
  • /
  • Pages.231-237
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  • 2009
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
권호 표지

절제 불가능한 4기 위암에서 예방적 위 공장 우회술의 의의

The Significance of Prophylactic Gastrojejunostomy for Patients with Unresectable Stage IV Gastric Cancer

  • 김환수 (고려대학교 의과대학 외과학교실) ;
  • 김종석 (고려대학교 의과대학 외과학교실) ;
  • 김종한 (고려대학교 의과대학 외과학교실) ;
  • 목영재 (고려대학교 의과대학 외과학교실) ;
  • 박성수 (고려대학교 의과대학 외과학교실) ;
  • 박성흠 (고려대학교 의과대학 외과학교실) ;
  • 장유진 (고려대학교 의과대학 외과학교실) ;
  • 김승주 (고려대학교 의과대학 외과학교실)
  • Kim, Hwan-Soo (Department of Surgery, Medical Science Graduate School, Korea University) ;
  • Kim, Chong-Suk (Department of Surgery, Medical Science Graduate School, Korea University) ;
  • Kim, Jong-Han (Department of Surgery, Medical Science Graduate School, Korea University) ;
  • Mok, Young-Jae (Department of Surgery, Medical Science Graduate School, Korea University) ;
  • Park, Sung-Soo (Department of Surgery, Medical Science Graduate School, Korea University) ;
  • Park, Seong-Heum (Department of Surgery, Medical Science Graduate School, Korea University) ;
  • Jang, You-Jin (Department of Surgery, Medical Science Graduate School, Korea University) ;
  • Kim, Seung-Joo (Department of Surgery, Medical Science Graduate School, Korea University)
  • 투고 : 2009.10.29
  • 심사 : 2009.10.30
  • 발행 : 2009.12.30
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초록

목적: 진행성 위암 중 수술 소견에서 복강 내 원격전이가 존재하거나 주위 장기에 침윤이 심하여 절제가 불가능한 경우에 위 배출구 폐색을 동반하지 않더라도 예방적 위공장 우회술을 시행하는 경우가 있어, 단순 개복술 시행과 비교하여 그 의의를 알고자 하였다. 대상 및 방법: 1984년부터 2007년까지 고려대학교 의료원에서 수술을 시행 받은 진행성 위암 환자 중 위 배출구 폐색이 없고 절제 불가능한 4기 위암 환자 167예를 대상으로, 후향적 방법을 이용하여 임상병리학적 특성 및 치료성적, 그리고 예후 인자 분석을 시행하였다. 결과: 위 공장 우회술을 시행과 단순 개복술 시행을 비교한 결과, 나이, 성별, 간 전이 여부, 술 후 재원일, 재입원 횟수에서는 유의한 차이를 없었지만, 병소의 위치(P$\leq$0.014), 복막 파종(P=0.001)에서는 유의한 차이를 보였다. 예후 인자 분석에서는 위 공장 우회술을 시행한 군의 생존기간이 1~35.7개월(6.3개월), 시행하지 않은 군이 1~33.4개월(median 4.3개월)로 유의한 차이가 있었으며(P=0.031), 복막전이가 있는 경우 1~31.0개월(median 3.4개월), 없는 경우 1~33.3개월(median 5.8개월)로 유의한 차이를 보였다(P<0.001). 다변량 분석을 통한 독립적 예후 인자로는 복막 전이 여부만이 의미가 있었다(P=0.002). 결론: 절제 불가능한 4기 위암 환자에서 폐색 증상이 없는 경우, 예방적 위 공장 우회술은 생존기간의 연장에서 큰 의의를 가지지 못하는 것으로 생각한다.

Purpose: The aim of this study was to evaluate the significance of palliative gastrojejunostomy for treating patients with unresectable stage IV gastric cancer, and as compared with laparotomy for treating patients with incurable gastric cancer. Materials and Methods: We retrospectively studied 167 patients who could not undergo resection without obstruction at Korea University Hospital from 1984 to 2007. They were classified into two groups, one that underwent palliative gastrojejnostomy (the bypass group, n=62) and one that underwent explo-laparotomy (the O&C group, n=105), and the clinical data and operative outcomes were compared according to the groups. Results: For the clinical characteristics, there were no differences of age, gender and liver metastasis between the bypass group and the explo-laparotomy group, but there was a significant different for the presence of peritoneal metastasis (P=0.001). There was no difference between two groups for the postoperative mortality and morbidity. For the postoperative outcomes, the duration of the hospital stay (29.25 vs 16.67) and the frequency of re-admission were not different, but the median overall survival (4.3 months vs. 3.4 months, respectively) was significantly different. By multivariate analysis, the presence of peritoneal metastasis was identified as the independent prognostic factor for incurable gastric cancer. Conclusion: A prophylactic bypass procedure is not effective for improving the quality of life and prolonging the life expectancy of unresectable stage IV gastric cancer patients without obstruction.

키워드

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