De Manzoni G, Di Leo A, Guglielmi A, Bonfiglio M, Leopardi F, Laterza E, Borzellino G
Istituto di Semeiotica Chirurgica, Università degli Studi, Verona.
Minerva Chir. 2000 Mar;55(3):105-11.
The aim of the present study was to evaluate the incidence of abdominal lymph node involvement of adenocarcinoma of the gastric cardia in relationship with the site and depth of tumor invasion.
From July 1988 to April 1998, 79 patients with adenocarcinoma of the gastric cardia underwent surgical curative resection and D2 lymphadenectomy at the 1st Department of General Surgery of Verona University. Among these 79 patients, 16 had an adenocarcinoma of the distal esophagus (type I), 26 patients had an adenocarcinoma of the anatomic cardia (type II) and 37 had a subcardial adenocarcinoma (type III). The frequency of lymph node involvement in each of the lymph nodes as classified by the JRSGC were analyzed.
In type I carcinoma positive lymph nodes occurred in 20% of pT1, 33% of pT2 and 100% of pT3. Positive nodes along the lower half of the stomach were never found. In type II carcinoma positive lymph nodes occurred in 57% of pT1, 86% of pT2 and 83% of pT3. Metastasis along the greater curvature in 18% of advanced cancers were found. In type III carcinoma positive lymph nodes occurred in 83% of pT2, 94% of pT3 and in 100% of pT4. Nodes along greater curvature were involved in 21% of advanced cases and also infrapyloric lymph nodes involved in 13% of cases. The type II and III advanced tumors had involved paraortic lymph node in 33% of cases.
These results suggest that for tumors of the cardia an extended lymphadenectomy is necessary to ensure the removal of all metastatic nodes.
本研究旨在评估贲门腺癌腹主动脉旁淋巴结受累情况与肿瘤浸润部位及深度的关系。
1988年7月至1998年4月，79例贲门腺癌患者在维罗纳大学第一普通外科接受了根治性手术切除及D2淋巴结清扫术。这79例患者中，16例为远端食管癌（I型），26例为解剖学贲门腺癌（II型），37例为贲门下腺癌（III型）。分析了日本胃癌学会（JRSGC）分类的各淋巴结中淋巴结受累的频率。
I型癌中，pT1期阳性淋巴结发生率为20%，pT2期为33%，pT3期为100%。胃下半部从未发现阳性淋巴结。II型癌中，pT1期阳性淋巴结发生率为57%，pT2期为86%，pT3期为83%。18%的进展期癌出现沿大弯侧转移。III型癌中，pT2期阳性淋巴结发生率为83%，pT3期为94%，pT4期为100%。21%的进展期病例出现沿大弯侧淋巴结受累，13%的病例出现幽门下淋巴结受累。II型和III型进展期肿瘤33%出现腹主动脉旁淋巴结受累。
这些结果表明，对于贲门肿瘤，扩大淋巴结清扫术对于确保清除所有转移淋巴结是必要的。
