Roviello Franco, Marrelli Daniele, Morgagni Paolo, de Manzoni Giovanni, Di Leo Alberto, Vindigni Carla, Saragoni Luca, Tomezzoli Anna, Kurihara Hayato
Unit of Surgical Oncology, University of Siena, Italy.
Ann Surg Oncol. 2002 Nov;9(9):894-900. doi: 10.1007/BF02557527.
The survival benefit of extended lymphadenectomy in the surgical treatment of gastric cancer is still being debated. The aim of this longitudinal multicenter study was to evaluate long-term survival in a group of patients with involvement of second level lymph nodes, which would not have been removed in the case of a limited lymphadenectomy. Results were compared with those in patients with involvement of first level lymph nodes.
Between 1991 and 1997, 451 patients with primary gastric cancer underwent curative resection with extended lymphadenectomy at three surgical departments in Italy according to the rules of the Japanese Research Society for Gastric Cancer.
In 451 cases treated by extended lymphadenectomy, morbidity and mortality rates were 17.1% and 2%, respectively. In 126 patients (27.9%) (group A), metastases were found in lymph node stations 7 to 12; 109 patients (24.2%) had metastases confined to the first level (group B). Lymph node stations 7 and 8 showed the highest incidence of metastases in the second level (17.1% and 12.4%, respectively). A significant difference in 5-year survival was observed between group A and group B (32% vs. 54%; P =.0005). This difference disappeared when cases were stratified according to the number of positive lymph nodes. By multivariate analysis, only the number of positive lymph nodes (relative risk, 1.8; P <.0001) and the depth of invasion (relative risk, 2.1; P <.0001), but not the level of involved nodes, showed to be independent predictors of poor prognosis.
Japanese-type extended lymphadenectomy yields low morbidity and mortality rates if performed in specialized centers. This procedure could provide a good probability of long-term survival, even for patients with involvement of regional lymph nodes.
在胃癌手术治疗中，扩大淋巴结清扫术的生存获益仍存在争议。这项纵向多中心研究的目的是评估一组第二站淋巴结受累患者的长期生存情况，这些患者在进行有限淋巴结清扫术时不会被清扫。将结果与第一站淋巴结受累患者的结果进行比较。
1991年至1997年期间，451例原发性胃癌患者在意大利的三个外科科室按照日本胃癌研究学会的规则接受了扩大淋巴结清扫术的根治性切除。
在451例行扩大淋巴结清扫术的病例中，发病率和死亡率分别为17.1%和2%。在126例患者（27.9%）（A组）中，在第7至12站淋巴结发现转移；109例患者（24.2%）的转移局限于第一站（B组）。第7和第8站淋巴结在第二站中的转移发生率最高（分别为17.1%和12.4%）。A组和B组之间观察到5年生存率有显著差异（32%对54%；P = 0.0005）。当根据阳性淋巴结数量对病例进行分层时，这种差异消失。通过多变量分析，只有阳性淋巴结数量（相对风险，1.8；P < 0.0001）和浸润深度（相对风险，2.1；P < 0.0001），而不是受累淋巴结的站数，显示为预后不良的独立预测因素。
如果在专业中心进行，日本式扩大淋巴结清扫术的发病率和死亡率较低。即使对于区域淋巴结受累的患者，该手术也能提供良好的长期生存概率。
