Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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The Surgical Diagnosis for Detecting Early Gastric Cancer and Lymph Node Metastasis: Its Role for Making the Decision of the Limited Surgery

조기위암 및 림프절 전이에 대한 수술 중 외과적 병기판정의 정확도 및 유용성

  • Park, Eun-Kyu (Department of Surgery, Chonnam National University Medical School) ;
  • Jeong, Oh (Department of Surgery, Chonnam National University Medical School) ;
  • Ryu, Seong-Yeop (Department of Surgery, Chonnam National University Medical School) ;
  • Ju, Jae-Kyun (Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Dong-Yi (Department of Surgery, Chonnam National University Medical School) ;
  • Jeong, Mi-Ran (Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Ho-Goon (Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Hoe-Won (Department of Surgery, Chonnam National University Medical School) ;
  • Park, Young-Kyu (Department of Surgery, Chonnam National University Medical School)
  • 박은규 (전남대학교 의과대학 외과학교실) ;
  • 정오 (전남대학교 의과대학 외과학교실) ;
  • 류성엽 (전남대학교 의과대학 외과학교실) ;
  • 주재균 (전남대학교 의과대학 외과학교실) ;
  • 김동의 (전남대학교 의과대학 외과학교실) ;
  • 정미란 (전남대학교 의과대학 외과학교실) ;
  • 김호군 (전남대학교 의과대학 외과학교실) ;
  • 김회원 (전남대학교 의과대학 외과학교실) ;
  • 박영규 (전남대학교 의과대학 외과학교실)
  • Published : 2009.09.30
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Abstract

Purpose: The aim of this study is to evaluate the accuracy of surgically diagnosing early gastric cancer (EGC) and lymph node metastasis, and to determine its role for performing limited surgery for EGC. Materials and Methods: We reviewed 369 patients who underwent gastrectomy for primary gastric carcinoma. The surgical diagnosis was evaluated by determining its sensitivity, specificity and accuracy, and this was compared with the preoperative examinations. Results: The sensitivity, specificity, and accuracy of the intraoperative diagnosis for EGC were 74.5%, 95.7% and 83.7%, respectively. The predictive value for EGC according to the intraoperative diagnosis was 95.7%. The surgical diagnosis of EGC showed higher specificity and a higher predictive value than preoperative examinations, which significantly reduced the risk of underestimating advanced gastric cancer (AGC) to EGC. The sensitivity, specificity, and accuracy for lymph node metastasis according to the surgical diagnosis were 73.2%, 78.1% and 76.4%, respectively. For 70 patients with a discrepancy in the diagnosis of EGC between the pre- and intra-operative diagnosis, the surgical diagnosis was correct in 63 (90%) patients, but the preoperative examinations were correct in only 7 (10%) patients. Conclusion: The surgical diagnosis showed better accuracy than the preoperative examinations for detecting EGC and lymph node metastasis. Our results suggest that the decision for conducting limited surgery based on the surgical diagnosis might reduce the risk of under-treatment of AGC to EGC better than the preoperative examinations.

목적: 조기위암 및 림프절 전이에 대한 수술 중 외과적 병기판정의 정확도에 대하여 분석하고, 외과적 병기에 근거한 수술 범위 판단의 유용성에 대하여 조사하고자 하였다. 대상 및 방법: 2006년에서 2007년까지 위암으로 위 절제술을 시행 받은 369명을 대상으로 조기위암 및 림프절 전이에 대한 수술 전 검사 및 외과적 병기판정의 민감도, 특이도 및 정확도를 비교 분석하였다. 결과: 조기위암에 대한 외과적 병기판정의 민감도, 특이도, 정확도는 각각 74.5%, 95.7%, 83.7%였으며 양성 예측도는 95.7%였다. 이는 수술 전 검사에 의한 조기위암의 진단에 비하여 높은 특이도와 양성 예측도를 보였다. 림프절 전이에 대한 외과적 병기판정의 민감도, 특이도 및 정확도는 73.2%, 78.1%. 76.4%였다. 127명의 림프절 전이 환자 중 수술 전 진단에서 59명(46.5%)이, 외과적 병기판정에 의해서는 34명(26.8%)만이 림프절 전이 없음으로 저 평가되었다. 조기위암의 진단에서 술 전 진단과 외과적 병기 사이에 불일치를 보인 70예 가운데, 63예(90%)는 외과적 병기판정이, 7예(10%)는 수술 전 진단이 정확하였다. 결론: 수술 중 외과의사에 의한 외과적 병기판정은 조기 위암 및 림프절 전이에 대하여 수술 전 검사에 비하여 높은 정확도를 보이고 진행위암의 조기위암으로의 저 평가를 현저히 줄인다. 따라서 위암의 수술 시 외과적 병기는 수술 범위를 결정하는데 있어서 중요한 인자로 고려되어야 한다.

Keywords

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