Mide kanserinde peritoneal yayılımda risk faktörleri
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Dosyalar
Tarih
2012
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Mide kanserli hastalarda tümörün yayılımı, lenf nodu tutulumu ve cerrahi rezeksiyonun şekli prognozu etkileyen en önemli faktörlerdir. Peritoneal yayılımda sağkalım olumsuz yönde etkilenmektedir. Bu durumda küratif amaçlı cerrahi uygulanamamakta veya küratif cerrahi uygulanan hastalarda kısa sürede peritoneal rekürrens meydana gelmektedir. Peritoneal lavaj sitolojik incelenmesi ile mikroskobik peritoneal yayılım saptanabilmektedir. Peroperatif saptanan mikroskobik peritoneal yayılımda tedavi planı değişmekte ve adjuvan kemoterapi yapılacak hasta seçiminde yararlı olmaktadır. Trakya Üniversitesi Tıp Fakültesi Genel Cerrahi Servisi'nde Şubat 2011-Ocak 2012 tarihleri arasında mide kanseri tanısı almış olan, makroskopik peritoneal yayılımı olmayan 41 hasta çalışmaya dahil edildi. Peroperatif peritoneal lavaj uygulandı. Peritoneal yıkama sıvısından aspirat alındı ve sitolojik inceleme yapıldı. Sitolojik inceleme sonuçları ile lenf nodu tutulumu, prognostik tip, tümörün lokalizasyonu, perinöral invazyon, serumda ve peritoneal yıkama sıvısındaki tümör belirteçleriyle ilişkisi araştırıldı. Hastaların 15 (%36,6)'i kadın, 26 (%63,4)'sı erkekti. Hastalarda en düşük yaş 36 iken en büyük yaş 83 olarak tespit edildi, ortalama yaş 62,61±12,29 idi. Laparotomiyi takiben karın içine 200 ml ılık serum fizyolojik verildi ve aspitrat sıvısı santrifüje edildikten sonra, Papanicolaou, May Grünwald-Giemsa ile boyandı ve deneyimli sitopatolog tarafından incelendi. Sonuçlar malin hücreler ve normal hücreler olarak bildirildi. Opere edilen 41 hastadan 10 (%24,4)'unda malin sitoloji pozitif iken, 31 (%75,6)'inde malin sitoloji negatif olarak tespit edildi. Seroza invazyonu olmayan 13 (%31,7) hastadan sadece 1 (%7,2) tanesinde malin sitoloji pozitifliği saptandı. Seroza invazyonu olan 28 hastadan (%68,3), 9 (%32,1)'unda malin sitoloji pozitifliği saptanmıştır. Malin sitoloji pozitif ve negatif olan hastalarda serumda ve peritoneal yıkama sıvısında karsino embriyonik antijen, kanser antijeni 19-9 ve alfa feto protein düzeyleri ile malin sitoloji arasında istatistiki anlamlı bir ilişki saptanmadı. Opere edilen 41 hastadan 5 (%12,2)'i kardia, 13 (%31,7)'ü korpus yerleşimli olarak tespit edildi ve kardia ve korpus yerleşimli mide kanserlerinde peritoneal yayılım anlamlı şekilde yüksek bulundu. Evre I ve II mide kanserli hasta sayısı 14 (%34,1), evre III ve IV hasta sayısı ise 27 (%65,9)'di. Evre I ve II hastalarda sadece 1 (%7,1) malin sitoloji pozitifliği, evre III ve IV hastalarda 9 (%33,3) malin sitoloji pozitifliği tespit edildi. Peritoneal malin hücre pozitifliği ile evre, yaş, invazyon derinliği, tümör lokalizasyonu arasında pozitif bir ilişki olduğu saptanmıştır. Anahtar kelimeler: Gastrik kanser, peritoneal yayılım, karsino embriyonik antijen, kanser antijeni 19-9, alfa feto protein.
Abstract
Tumour dissemination, lymph node involvement and surgical resection technique are the most important factors affecting patient prognosis with gastric cancer. Peritoneal dissemination adversely affects the survival rate in patients. In these cases curative surgery is not performed or peritoneal re-occurrence is observed in a short period of time in those patients who do have curative surgery performed. Microscopic peritoneal dissemination can be detected with peritoneal lavage cytological examination. Peroperatively detected microscopic peritoneal dissemination changes the treatment plan for patients and can be useful when selecting patients who should undergo adjuvant chemotherapy. At the Trakya Universtity Faculty of Medicine, General Surgery Department, a 41 year old patient who was macroscopic peritoneal dissemination during the dates January- December 2011 was included in the study. Peri-operative peritoneal lavage was performed and cytological examination of peritoneal aspirate carried out. Using tumour markers the relationship between lymph node metastasis, prognostic type, tumour location and peri-neural invasion was investigated on the serum and peritoneal fluid. In the study 15 (36,6%) of the patients were female and 26 (63,4%) were male. The youngest patient was 36 years old, the eldest being 83 with an average age of 62,61±12,29. Following entering the abdomen via laparotomy, 200 ml of saline was given and following centrifugation the aspirated fluid was stained with Papanicolaou, May Grünwald-Giemsa and examined by an experienced cytopathologist. Results were reported as being both malignant cells as well as normal cells. Forty one patients that were operated on, 10 of them (24,4%) had positive malignant cytology and 31 (75,7%) had negative cytology. Just 1 (7,2%) patient was found to have positive cytology out of 13 (31,7%) that did not have serous invasion. Of the 28 (68,3%) patients with serous invasion, 9 patients (32,1%) were found to have positive cytology. No significant pattern was detected in the carcino embryionic antigen, cancer antigen 19-9 and alpha feto protein levels in both the positive and negative cytology serum and peritoneal lavage fluid. Of the 41 patients operated on 5 (12,2%) were found to have cardia dissemination and 13 (31,7%) were found to have dissemination located at the corpus. Peritoneal dissemination was found to be significantly high in gastric cancer located in the cardia and corpus . Fourteen (34,1%) of the patients had stage I and stage II cancer and 27 (65,9%) of patient?s had cancer in stages III and IV. Just 1 (7,1%) patient with stage I or II cancer was found to have positive malignant cytology, however 9 (33,3%) patient?s of stage III and IV gastric cancer patients were tested positively for malignant cytology. A positive relationship was detected in the positive peritoneal cell malignancy with cancer stage, age, invasion depth and tumour location in patients. Key Words: Gastric cancer, peritoneal dissemination, carcino embrionic antigen, cancer antigen 19-9, alpha feto protein.
Abstract
Tumour dissemination, lymph node involvement and surgical resection technique are the most important factors affecting patient prognosis with gastric cancer. Peritoneal dissemination adversely affects the survival rate in patients. In these cases curative surgery is not performed or peritoneal re-occurrence is observed in a short period of time in those patients who do have curative surgery performed. Microscopic peritoneal dissemination can be detected with peritoneal lavage cytological examination. Peroperatively detected microscopic peritoneal dissemination changes the treatment plan for patients and can be useful when selecting patients who should undergo adjuvant chemotherapy. At the Trakya Universtity Faculty of Medicine, General Surgery Department, a 41 year old patient who was macroscopic peritoneal dissemination during the dates January- December 2011 was included in the study. Peri-operative peritoneal lavage was performed and cytological examination of peritoneal aspirate carried out. Using tumour markers the relationship between lymph node metastasis, prognostic type, tumour location and peri-neural invasion was investigated on the serum and peritoneal fluid. In the study 15 (36,6%) of the patients were female and 26 (63,4%) were male. The youngest patient was 36 years old, the eldest being 83 with an average age of 62,61±12,29. Following entering the abdomen via laparotomy, 200 ml of saline was given and following centrifugation the aspirated fluid was stained with Papanicolaou, May Grünwald-Giemsa and examined by an experienced cytopathologist. Results were reported as being both malignant cells as well as normal cells. Forty one patients that were operated on, 10 of them (24,4%) had positive malignant cytology and 31 (75,7%) had negative cytology. Just 1 (7,2%) patient was found to have positive cytology out of 13 (31,7%) that did not have serous invasion. Of the 28 (68,3%) patients with serous invasion, 9 patients (32,1%) were found to have positive cytology. No significant pattern was detected in the carcino embryionic antigen, cancer antigen 19-9 and alpha feto protein levels in both the positive and negative cytology serum and peritoneal lavage fluid. Of the 41 patients operated on 5 (12,2%) were found to have cardia dissemination and 13 (31,7%) were found to have dissemination located at the corpus. Peritoneal dissemination was found to be significantly high in gastric cancer located in the cardia and corpus . Fourteen (34,1%) of the patients had stage I and stage II cancer and 27 (65,9%) of patient?s had cancer in stages III and IV. Just 1 (7,1%) patient with stage I or II cancer was found to have positive malignant cytology, however 9 (33,3%) patient?s of stage III and IV gastric cancer patients were tested positively for malignant cytology. A positive relationship was detected in the positive peritoneal cell malignancy with cancer stage, age, invasion depth and tumour location in patients. Key Words: Gastric cancer, peritoneal dissemination, carcino embrionic antigen, cancer antigen 19-9, alpha feto protein.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Gastrik Kanser, Peritoneal Yayılım, Karsino Embriyonik Antijen, Kanser Antijeni 19-9, Alfa Feto Protein, Gastric Cancer, Peritoneal Dissemination, Carcino Embrionic Antigen, Cancer Antigen 19-9, Alpha Feto Protein
