4기 위암의 적절한 치료법은?

Abstract

Among 2118 patients with gastric cancer who had undergone gastric resection in the Department of Sursery, Yonsei University College of Medicine over the 7 years period from January 1987 to December 1993, there were 214(10.l%) with stage IV gastric cancer, designated as a lesion with factors such as direct invasion of adjacent organs(T factor), tertiary or quaternary nodal involvement(N factor), peritoneal metastasis(P factor) or hepatic metastasis(H factor). The overall 5-year survival rate in patients with stage IV gastric cancer after gastric resection was 11.3%. The 5-year survival rate in patients without distant metastasis(n=122) was 17.5%, being significantly higher than the 4.4% in cases with distant metastasis(n=92). Patients with tertiary nodal involvement or directly invaded organs alone survived at a rate of 23.8% and 10.2% in the 5-year follow-up, respectively. Signifi cant difference in 5-year survival rates were also noted in curability(curative resection:22.3 %, palliative resection: 5.1%) and type of operation(subtotal: 15.6%, total: 6.0%). But the mean survival time was less than 10months in patients with more than 2 factors in combination. In conclusion, there appear to be 2 subgroups in whom the rates of survival differ in stage IV gastric cancer according to distant metastasis. Therefore radical procedures such as extended lymphadenectomy and combined resection of invaded organ should be performed in M0 cases. On the other hand, in Ml cases, consideration and adaptation of new therapeutic approach except gastric resection will improve the survival and quality of life.