Stein Hubert J, Sendler Andreas, Siewert Jörg R
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675 München, Germany.
Surg Oncol Clin N Am. 2002 Apr;11(2):405-14. doi: 10.1016/s1055-3207(02)00017-0.
In addition to tumor stage and growth pattern, the tumor site is a major factor in determining the extent of resection and lymphadenectomy necessary in patients with gastric carcinoma. Total gastrectomy with D2-lymphadenectomy is the procedure of choice for tumors of the gastric corpus. Extended total gastrectomy with trans-hiatal resection of the distal esophagus is required for tumors of the proximal region; in these patients lymphadenectomy may also include splenic hilum and left retroperitoneal nodes. In patients with distal gastric carcinoma, a subtotal gastrectomy often achieves a complete tumor resection. Extended lymphadenectomy in these patients includes the retroduodenal and right para-aortic nodes in addition to a D2-dissection. In patients with early tumor stages, anatomically oriented limited resection techniques are increasingly important. The concept of the sentinel lymph node may result in more selective lymphadenectomy strategies in the near future [15]. For patients with a locally advanced disease, these surgical concepts must be evaluated within multimodal treatment protocols [16].
除肿瘤分期和生长方式外，肿瘤部位是决定胃癌患者所需切除范围和淋巴结清扫范围的主要因素。胃体部肿瘤的首选手术方式是D2淋巴结清扫的全胃切除术。近端区域肿瘤需要行扩大全胃切除术并经裂孔切除远端食管；这些患者的淋巴结清扫还可能包括脾门和左腹膜后淋巴结。对于远端胃癌患者，次全胃切除术通常可实现肿瘤完全切除。这些患者的扩大淋巴结清扫除D2清扫外，还包括十二指肠后和右主动脉旁淋巴结。在肿瘤早期患者中，解剖学导向的有限切除技术日益重要。前哨淋巴结的概念可能在不久的将来带来更具选择性的淋巴结清扫策略[15]。对于局部进展期疾病患者，必须在多模式治疗方案中评估这些手术概念[16]。
