Résumé
Purpose@#Type 4 gastric cancer (GC) has a very poor prognosis even after curative resection, and the survival benefit of splenectomy for splenic hilar lymph node (LN; #10) dissection in type 4 GC remains equivocal. This study aimed to clarify the clinical significance of splenectomy for #10 dissection in patients with type 4 GC. @*Materials and Methods@#The data of a total of 56 patients with type 4 GC who underwent total gastrectomy with splenectomy were retrospectively analyzed. Postoperative morbidity, state of LN metastasis, survival outcomes, and therapeutic value index (TVI) of each LN station were evaluated. TVI was calculated by multiplying the incidence of LN metastasis at each nodal station and the 5-year overall survival (OS) of patients who had metastasis to each node. @*Results@#Overall, the postoperative morbidity rate was 28.6%, and the incidence of #10 metastasis in the patients was 28.6%. The 5-year OS rate for all patients was 29.9%, and most patients developed peritoneal recurrence. Moreover, the 5-year OS rates with and without #10 metastasis were 6.7% and 39.1% (median survival time, 20.4 vs. 46.0 months; P=0.006). The TVI of #10 was as low as 1.92. @*Conclusions@#The clinical significance of splenectomy in the dissection of #10 for type 4 GC is limited and splenectomy for splenic hilar dissection alone should be omitted.
Résumé
Objective: To investigate the current state of awareness and practice among hospital staff in advance care planning (ACP). Methods: A total of 782 hospital staff workers were administered an anonymous questionnaire. Results: Among the participants, 27.7% answered “I have discussed the will of end-of-life care in family.” and 11.0% answered “I have discussed the surrogate decision maker.” Moreover, only 1.1% of the respondents answered “I have made document of end-of-life care in family.” Conclusion: The awareness and practice among hospital staff in ACP is still developing, suggesting the need for more knowledge and experience.