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ID naloge: 157 Letnik: 2003 Predmet: kirurgija
PRIMERJAVA PREŽIVETJA R0 RESECIRANIH BOLNIKOV Z RAKOM ŽELODCA IN DANKE V UICC STADIJU pT3N0-2,3M0
Avtor: Tomaž Velnar
Mentor: doc. dr. Franc Jelenc
IZHODIŠCE: Rak želodca in danke sta v današnjem casu med zelo pogostimi vzroki smrti. Z njima obolevajo predvsem bolniki srednjih let. Najprej sta oba asimptomatska. Simptomi se pojavijo šele v kasnejšem obdobju bolezni, vendar pri raku danke prej kot pri želodcnem. Prav zaradi poznega nastopa simptomov je odkrivanje in zdravljenje oteženo. Osnovne preiskovalne metode so endoskopija, UZ trebuha in CT. Glavni nacin zdravljenja je kirurška resekcija, ki jo pri raku danke kombiniramo še z obsevanjem in kemoterapijo.
NAMEN: Skupen proces pri raku želodca in danke je transformacija zdrave celice v rakasto. Zacne se na sluznici , sledi širjenje v okolico in zasevanje. Gre za enak proces, zato bi moralo biti preživetje bolnikov z rakom želodca, operiranih v istih stadijih kot bolniki z rakom danke, enako. Proucevali smo dejavnike, ki vplivajo na preživetje bolnikov, pri katerih je bila narejena R0 resekcija.
HIPOTEZA: Predpostavili smo, da je preživetje bolnikov z rakom želodca in danke, ki so bili R0 resecirani v stadiju pT3N0-2,3M0, enako.
METODE: V retrospektivno raziskavo smo vkljucili 74 bolnikov. Operirani so bili v obdobju od 1.1.1998 do 24.12.2000 v Klinicnem centru v Ljubljani, na Klinicnem oddelku za abdominalno kirurgijo. Pri obdelavi podatkov smo uporabili program Statistica. Krivulje preživetja smo izracunali po Kaplan-Meierjevi metodi. Med seboj smo jih primerjali z Mantel-Coxovim (log- rank) testom.
REZULTATI: V tem obdobju je bilo zaradi raka želodca in danke v stadiju pT3N0-2,3M0 operiranih 74 bolnikov (47 z rakom želodca in 27 z rakom danke). Pri vseh je bila narejena R0 resekcija. Srednja starost bolnikov z rakom želodca je bila 68 let, rakom danke pa 67 let. Petletno preživetje se je mocno razlikovalo. Po resekciji raka želodca je bilo preživetje 22,2%, po resekciji raka danke pa 81,7% (p = 0,0000).
ZAKLJUCKI: Naše hipoteze, da je da preživetje R0 reseciranih bolnikov z rakom želodca in danke enako, nismo potrdili. Kljub popolni odstranitvi tumorja in operaciji v istem stadiju, je bilo preživetje pri raku želodca precej slabše. Vzroki za to so: vecja agresivnost želodcnega raka, ki se kaže v slabi celicni diferenciaciji in zgodnji žilni in perinevralni invaziji, poznem nastopu simptomov in težjem odkrivanju raka.
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[Abstract / English version]
PRIMERJAVA PREŽIVETJA R0 RESECIRANIH BOLNIKOV Z RAKOM ŽELODCA IN DANKE V UICC STADIJU pT3N0-2,3M0
Author: Tomaž Velnar
Mentor: doc. dr. Franc Jelenc
BACKGROUND: Gastric and rectal cancers are frequent causes of death among middle-aged people throughout the world. Both are asymptomatic in the beginning, symptoms emerge only in the late period of the disease; in colorectal cancer earlier than in gastric cancer. The detection and cure is aggravated because of the late onset of symptoms. Basic examining methods are CT, ultrasound and endoscopy. For gastric cancer surgery is used, in colorectal it is combined with chemotherapy and irradiation.
AIM: The transformation of a healthy cell is a common process both in gastric and rectal cancer. It starts in the mucosa and spreads to adjacent structures and metastasizes early. The 5-year survival should be equal for patients with gastric and colorectal cancer that were R0 resected in stage pT3N0-2,3M0, because it is an identical process. We studied the facts that influenced the survival.
HYPOTHESIS: We assumed that survival for R0 resected patients with pT3NM0 gastric and colorectal carcinoma is equal.
METHODS: 74 patients were included in our study. They were treated from 1.1.1998 to 24.12.2000 at Clinical department for abdominal surgery in Clinical center in Ljubljana. Statistical data was processed using the Statistica computer programme. The curves were calculated according to the Kaplan-Meier method. They are compared using the Mantel-Cox test.
RESULTS: There were 74 patients treated during our time scale (47 with gastric and 27 with rectal cancer). All were R0 resected in pT3N0-2,3M0 stage. Mean age of gastric cancer patients was 68 years, of colorectal 67 years. 5-year survival was very different: 22.2% for gastric and 81.7% for colorectal cancer patients (p = 0.0000).
CONCLUSIONS: The hypothesis, that the 5-year survival of the patients with gastric and rectal cancer in pT3N0-2,3M0 stage is equal, was not confirmed. Survival was significantly worse in gastric cancer, despite total resection being performed. The aggressiveness of the disease, the vascular and perineural invasion, the late onset of symptoms, and the slow detection are among the causes.
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