Vol.13, No 1, 2006 pp. 19 - 24
UC 616.33-006.6-089
THE
ROLE OF PREOPERATIVE STAGING OF GASTRIC CANCER
IN PLANNING RADICAL SURGICAL TREATMENT
Aleksandar V. Zlatić, Milan Radojković, Nebojša
Ignjatović, Miroslav Stojanović, Ljiljana Jeremić
Surgical Clinic, Clinical Center, Niš
E-mail: a.zlatic@eunet.yu
Summary. Although gastric cancer incidence is gradually
decreasing, it is still the most common cause of death of all digestive
system cancers. The aim of preoperative staging is to estimate the
possibility of complete resectability of the tumor and the metastatic
involvement of lymph nodes. Only if preoperative staging is indicative
of R0, the prognosis of the disease can be ameliorated using surgical
procedures. This study is based on the analysis of the clinical data of
65 gastric cancer patients (35 males, 30 females, aged 37-83), treated
at Surgical Clinic, Niš Clinical Center, during the period 2000-2001,
who underwent targeted preoperative diagnostic actions in order for
preoperative and intra-operative staging to be determined. Clinical,
morphological (macroscopic, microscopic, histochemical) and statistic
research was done in all patients. In 38% of them, preoperative and
intra-operative findings coincided, and in 60% patients a higher level
of gastric cancer was identified, while in 2% it was lower. A
significant correlation between the preoperative estimate of gastric
cancer and the intra-operative finding was determined (r = 0.630; p
< 0.001). The preoperative staging coincided with the definite one
in 45% cases. In equal percent it was overestimated, mostly at stage
II, when the percent of coincidence was only 33%. Only in 5% cases the
preoperative staging was underestimated in relation to the
postoperative one. The highest coincidence was at stadium IV, which is
expected, as the last stadium is the easiest to detect but,
unfortunately, the chances for survival are minimal. These results show
that not even the modern diagnostic methods can give satisfactory
results in the preoperative estimate of the disease and that a
macroscopic appearance of lymph nodes is not sufficient for the
estimation of the presence of metastatic deposits. For these reasons,
modern TNM classification is not only based on preoperative and
operative findings, but also on the pathohistological finding of the
relevant specimen (pTNM).
Key words: Gastric cancer,
preoperative staging, radical treatment
ULOGA PREOPERATIVNOG STADIJUMA
(STAGING) MALIGNOMA ŽELUCA
U PLANIRANJU RADIKALNOSTI HIRURŠKOG LEČENJA
Kratak sadržaj: Iako je učestalost karcinoma želuca u postepenom
opadanju, još uvek je najčešći uzrok smrti od svih karcinoma
digestivnog trakta. Cilj određivanja preoperativnog stadijuma bolesti
je utvrđivanje mogućnosti kompletne resektabilnosti tumora i
metastatske zahvaćenosti limfatičnog drenažnog sistema. Jedino ako na
osnovu preoperativnog stadijuma očekujemo R0, resekciju prognoza
bolesti može biti poboljšana hirurškim zahvatom. Ispitivanje je
obuhvatilo grupu od 65 pacijenata sa karcinomom želuca (35 muškaraca i
30 žena, starosne dobi od 37-83 godina), koji su lečeni na
Hirurškoj klinici u Nišu u periodu od 1.1.2000. god. do 1.11.2001. god.
i kod kojih su urađjeni ciljani preopeerativni dijagnostički postupci
uz težnju određivanja kako preoperativnog, tako i intraopertaivnog
stadijuma. Kod svih pacijenata primenjivana su klinička, morfološka
(makroskopska, mikroskopska i histohemijska) i statistička ispitivanja.
U 38% se preoperativni i intraoperativni nalaz poklapao, u 60%
ispitanika je intraoperativno utvrđen viši stepen proširenosti
karcinoma želuca, dok je u 2% bio niži. Utvrđena je signifikantna
korelacija nalaza preoperativne procene proširenosti karcinoma želuca u
odnosu na intraoperativni nalaz ali sa korelacionim koeficijentom od r
= 0,630 (p < 0,001). Preoperativni staging bio je saglasan sa
definitivnim u 45% ispitivanih slučajeva. U jednakom procentu bio je
precenjen, najviše kod II stadijuma gde je procenat saglasnosti
samo 33%. Samo u 5% je preoperativni staging bio potcenjen u odnosu na
postoperativni. Najveći procenat poklapanja bio je kod IV stadijuma što
je razumljivo, jer se poslednji stadijum najlakše detektuje ali su na
žalost kod ovih pacijenata šanse za preživljavanje minimalne. Ovakvi
rezultati istraživanja ukazuju da ni savremene dijagnostičke
metode još uvek ne mogu da daju zadovoljavajuće rezultate u
preoperativnoj proceni bolesti kao i da makroskopski izgled limfnih
nodusa nije dovoljan da se oceni prisustvo metastatskih depozita. Iz
ovih razloga se savremena TNM klasifikacija bazira, kako na
preoperativnom i operativnom nalazu, tako i na patohistološkom nalazu
resekovanog preparata (pTNM).
Ključne reči: Karcinom želuca,
preoperativni staging, radikalitet
