Mönig S P, Collet P H, Baldus S E, Schmackpfeffer K, Schröder W, Thiele J, Dienes H P, Hölscher A H
Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
J Surg Oncol. 2001 Feb;76(2):89-92. doi: 10.1002/1096-9098(200102)76:2<89::aid-jso1016>3.0.co;2-i.
The indication for splenectomy in proximal gastric cancer remains controversial. Splenectomy is performed because of possible lymph node metastasis of the splenic hilus or infiltration/metastasis of the spleen. The purpose of this study was to investigate the frequency of lymph node metastasis to the splenic hilus and metastasis to the spleen in proximal gastric carcinomas.
In a morphologic study, the frequency of lymph node metastasis to the splenic hilus in 112 patients with proximal gastric cancer was investigated with particular emphasis on its correlation with established clinicopathological characteristics and classifications. Seventy-seven gastrectomy specimens were obtained from men and 35 from women. Patients ranged in age from 20 to 89 years (median 60 years). All patients underwent a potential curative resection (RO resection) with total gastrectomy and pancreas-preserving splenectomy. None of the patients had been treated preoperatively with cytotoxic drugs or radiation.
A mean number of three lymph nodes (range 0-8) in the splenic hilus was found in each specimen. The incidence of lymph node metastasis of the splenic hilus was 9.8% (n=11). Lymph node metastasis was only observed in advanced proximal gastric cancer (UICC IIIb/IV) located at the greater curvature and in Borrmann type III/IV cancer with advanced lymph node metastasis. An infiltration of the spleen was seen only in two cases with advanced stages of gastric carcinoma (stage IV).
Based on our data lymph node metastasis to the splenic hilus is rarely observed in proximal gastric cancer and only found in advanced cancer (UICC IIIb/IV) especially in tumors of the greater curvature and of Borrmann type IV cancer.
近端胃癌行脾切除术的指征仍存在争议。行脾切除术是因为脾门可能发生淋巴结转移或脾脏受侵/转移。本研究的目的是调查近端胃癌患者脾门淋巴结转移及脾脏转移的发生率。
在一项形态学研究中，调查了112例近端胃癌患者脾门淋巴结转移的发生率，并特别强调其与既定临床病理特征及分类的相关性。77例胃切除标本来自男性，35例来自女性。患者年龄范围为20至89岁（中位年龄60岁）。所有患者均接受了全胃切除及保留胰腺的脾切除的根治性切除（RO切除）。所有患者术前均未接受过细胞毒性药物或放疗。
每个标本中脾门平均有3个淋巴结（范围0 - 8个）。脾门淋巴结转移发生率为9.8%（n = 11）。仅在位于大弯侧的进展期近端胃癌（UICC IIIb/IV期）及伴有进展期淋巴结转移的Borrmann III/IV型癌中观察到淋巴结转移。仅在2例晚期胃癌（IV期）中发现脾脏受侵。
根据我们的数据，近端胃癌中脾门淋巴结转移很少见，仅在进展期癌（UICC IIIb/IV期）中发现，尤其是大弯侧肿瘤及Borrmann IV型癌。
