Yoshikawa Takaki, Tsuburaya Akira, Kobayashi Osamu, Sairenji Motonori, Motohashi Hisahiko, Noguchi Yoshikazu
Department of Gastrointestinal Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan.
Ann Surg Oncol. 2002 May;9(4):401-5. doi: 10.1007/BF02573876.
The objective of this study was to clarify a survival benefit of D2 lymphadenectomy in patients with early gastric carcinoma (GC).
A retrospective study was conducted to examine the incidence of metastasis to level 2 lymph nodes, the causes of postoperative death, and the mode of recurrence in 1041 patients who had early GC and underwent D2 lymphadenectomy with curative intent.
Postoperative mortality occurred in 129 (12.4%) of 1041 patients, 6 patients (.6%) died of surgical complications, 108 (10.2%) died of diseases other than cancer, and 16 (1.5%) died of recurrence. Hematogenous metastasis was the major mode of recurrence (56.3% of recurrences). The incidence of metastasis to level 2 nodes was 2.5% (26 of 1041 patients, 18 of whom were alive). Thus, the estimated survival benefit of radical lymphadenectomy for patients with early GC was calculated to be 1.7% (18 of 1041 patients).
D2 lymphadenectomy in patients with early GC had little survival benefit because (1) metastasis to level 2 nodes was rare, (2) most causes of death were not related to the tumor, and (3) more than half the recurrences were hematogenous. Use of radical lymphadenectomy for early GC should be limited.
本研究的目的是阐明D2淋巴结清扫术对早期胃癌（GC）患者的生存获益情况。
进行一项回顾性研究，以检查1041例早期GC且接受了根治性意图的D2淋巴结清扫术患者的第2站淋巴结转移发生率、术后死亡原因及复发模式。
1041例患者中有129例（12.4%）发生术后死亡，6例（0.6%）死于手术并发症，108例（10.2%）死于癌症以外的疾病，16例（1.5%）死于复发。血行转移是主要的复发模式（占复发的56.3%）。第2站淋巴结转移发生率为2.5%（1041例患者中的26例，其中18例存活）。因此，早期GC患者根治性淋巴结清扫术的估计生存获益计算为1.7%（1041例患者中的18例）。
早期GC患者行D2淋巴结清扫术的生存获益很小，原因如下：（1）第2站淋巴结转移罕见；（2）大多数死亡原因与肿瘤无关；（3）超过一半的复发是血行性的。早期GC根治性淋巴结清扫术的应用应受到限制。
