| ID | 65995 |
| 著者 |
Kakiuchi, Yoshihiko
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Kuroda, Shinji
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Choda, Yasuhiro
Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Otsuka, Shinya
Department of Surgery, Fukuyama Medical Center
Ueyama, Satoshi
Department of Surgery, Mihara Red Cross Hospital
Tanaka, Norimitsu
Department of Surgery, Kagawa Prefectural Central Hospital
Muraoka, Atsushi
Department of Surgery, Kagawa Rosai Hospital
Hato, Shinji
Department of Surgery, Shikoku Cancer Center
Kamikawa, Yasuaki
Department of Surgery, Matsuda Hospital
Fujiwara, Toshiyoshi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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| 抄録 | Purpose: Although proximal gastrectomy (PG) is commonly used in patients with upper gastric cancer (GC) and esophagogastric junction (EGJ) cancer, long-term prognostic factors in these patients are poorly understood. The double-flap technique (DFT) is an esophagogastrostomy with anti-reflux mechanism after PG; we previously conducted a multicenter retrospective study (rD-FLAP) to evaluate the short-term outcomes of DFT reconstruction. Here, we evaluated the long-term prognostic factors in patients with upper GC and EGJ cancer.
Methods: The study was conducted as a secondary analysis of the rD-FLAP Study, which enrolled patients who underwent PG with DFT reconstruction, irrespective of disease type, between January 1996 and December 2015. Results: A total of 509 GC and EGJ cancer patients were enrolled. Univariate and multivariate analyses of overall survival demonstrated that a preoperative prognostic nutritional index (PNI) < 45 (p < 0.001, hazard ratio [HR]: 3.59, 95% confidential interval [CI]: 1.93–6.67) was an independent poor prognostic factor alongside pathological T factor ([pT] ≥2) (p = 0.010, HR: 2.29, 95% CI: 1.22–4.30) and pathological N factor ([pN] ≥1) (p = 0.001, HR: 3.27, 95% CI: 1.66–6.46). In patients with preoperative PNI ≥45, PNI change (<90%) at 1-year follow-up (p = 0.019, HR: 2.54, 95%CI: 1.16–5.54) was an independent poor prognostic factor, for which operation time (≥300 min) and blood loss (≥200 mL) were independent risk factors. No independent prognostic factors were identified in patients with preoperative PNI <45. Conclusions: PNI is a prognostic factor in upper GC and EGJ cancer patients. Preoperative nutritional enhancement and postoperative nutritional maintenance are important for prognostic improvement in these patients. |
| キーワード | Double -flap technique
Gastric cancer
Prognostic factor
Prognostic nutritional index
Proximal gastrectomy
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| 備考 | © 2023 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
This fulltext file will be available in Sep. 2024.
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| 発行日 | 2023-10
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| 出版物タイトル |
Surgical Oncology
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| 巻 | 50巻
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| 出版者 | Elsevier BV
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| 開始ページ | 101990
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| ISSN | 0960-7404
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| 資料タイプ |
学術雑誌論文
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| 言語 |
英語
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| OAI-PMH Set |
岡山大学
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| 著作権者 | © 2023 Elsevier Ltd.
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| 論文のバージョン | author
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| PubMed ID | |
| DOI | |
| Web of Science KeyUT | |
| 関連URL | isVersionOf https://doi.org/10.1016/j.suronc.2023.101990
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| ライセンス | https://creativecommons.org/licenses/by-nc-nd/4.0
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