进展期胃癌行胰脾切除术的适应证

Indications for pancreaticosplenectomy in advanced gastric cancer.

作者信息

Chikara K, Hiroshi S, Masato N, Hirotoshi A, Goro M, Hidetaka O

机构信息

Second Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.

出版信息

Hepatogastroenterology. 2001 May-Jun;48(39):908-12.

PMID:11462954

Abstract

BACKGROUND/AIMS: The lymph nodes along the splenic artery (No. 11) and at the splenic hilum (No. 10) are classified in group 2 (n2) in the Japanese Classification of Gastric Carcinoma. Pancreaticosplenectomy is performed to achieve complete D2 dissection, but its efficacy remains controversial. To clarify the indications for pancreaticosplenectomy in gastric cancer, surgical results were investigated.

METHODOLOGY

This study investigated 111 gastric cancer patients who underwent potentially curative total gastrectomy with pancreaticosplenectomy accompanied by D2 or more extensive lymph node dissection. The rate of lymph node metastasis and the number of Nos. 10 and 11 lymph nodes that contained metastases were ascertained from several histopathological findings. Predictive factors for metastasis in lymph nodes Nos. 10 and 11 and prognostic factors for survival were calculated and compared using the univariate and Cox proportional hazard regression model.

RESULTS

Lymph node metastasis to No. 10 or 11 was observed in 19 patients. Of these, 8 (42.1%) had paraaortic lymph node metastases. The average number of metastatic lymph nodes in the 19 patients was 19.4 +/- 19.2. The location of the primary tumor and the number of metastatic lymph nodes were correlated to lymph node metastasis to Nos. 10 and 11. Of the regional lymph nodes, the right paracardial lymph nodes and those along the short gastric vessels frequently metastasized to No. 10 or 11. The 5-year survival rate of patients with metastases in lymph nodes No. 10 or 11 was 23.8% and that with No. 16 metastases was 24.5%, whereas that in n2 without metastasis in No. 10 or 11 was 41.4%. The independent prognostic factor was the number of metastatic lymph nodes. Of the postoperative complications, pancreatic fistula was observed in 43 patients (38.7%) and followed by anastomotic leakage in 6 (5.4%).

CONCLUSIONS

Pancreaticosplenectomy is indicated in patients with advanced gastric cancer in the upper third or the whole of the stomach and with lymph node metastasis at right paracardial or along the short gastric vessels. To obtain good surgical results, pancreaticosplenectomy with paraaortic lymph node dissection (D3) should be carried out in patients with as few metastatic lymph nodes as possible.

摘要

背景/目的：在日本胃癌分类中，脾动脉周围淋巴结（第11组）和脾门淋巴结（第10组）被归类为第2组（n2）。为实现完整的D2根治性清扫需行胰脾切除术，但其疗效仍存在争议。为明确胃癌胰脾切除术的适应证，对手术结果进行了研究。

方法

本研究调查了111例行根治性全胃切除术并伴有胰脾切除术及D2或更广泛淋巴结清扫的胃癌患者。从多项组织病理学检查结果中确定淋巴结转移率以及第10组和第11组有转移的淋巴结数量。使用单因素分析和Cox比例风险回归模型计算并比较第10组和第11组淋巴结转移的预测因素以及生存的预后因素。

结果

19例患者出现第10组或第11组淋巴结转移。其中，8例（42.1%）有主动脉旁淋巴结转移。这19例患者转移淋巴结的平均数量为19.4±19.2。原发肿瘤的位置和转移淋巴结的数量与第10组和第11组淋巴结转移相关。在区域淋巴结中，贲门右旁淋巴结和胃短血管旁淋巴结常转移至第10组或第11组。第10组或第11组淋巴结转移患者的5年生存率为23.8%，第16组淋巴结转移患者的5年生存率为24.5%，而第2组中第10组或第11组无转移患者的5年生存率为41.4%。独立的预后因素是转移淋巴结的数量。术后并发症方面，43例患者（38.7%）出现胰瘘，其次6例（5.4%）出现吻合口漏。