Ohno Masakazu, Nakamura Takeshi, Ajiki Tetsuo, Horiuchi Hideki, Tabuchi Yoshiki, Kuroda Yoshikazu
Department of Gastroenterological Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Hepatogastroenterology. 2003 Jul-Aug;50(52):1173-7.
BACKGROUND/AIMS: The effect of lymph node metastasis around the splenic artery on the prognosis of proximal gastric cancer patients is not confirmed. The aim of this study is to clarify the optimal procedure for lymph node dissection along the splenic artery in proximal gastric cancer.
Proximal gastric cancer patients who underwent total gastrectomy with pancreaticosplenectomy were examined. The anatomical location of lymph nodes and the metastases around the pancreas were also studied in pancreatic cancer patients who underwent total pancreatectomy.
Multivariate analysis of lymph node metastasis around the splenic artery showed that No. 11 lymph node metastasis was affected by No.10 lymph node that was predicted by depth of invasion. Multivariate analysis of prognostic variables by Cox's proportional hazard regression revealed that No. 10 lymph node metastasis was the significant factor affecting prognosis. No lymph node metastasis infiltrating the pancreatic parenchyma was observed in the pancreatic body or the tail.
Total gastrectomy preserving the pancreas and spleen is the optimal procedure in proximal T2 gastric cancer. Total gastrectomy with splenectomy is appropriate in T3 cases, and distal pancreatectomy should be additionally done only in cases of direct invasion by the lymph node and/or the tumor to the pancreas.
背景/目的:脾动脉周围淋巴结转移对近端胃癌患者预后的影响尚未得到证实。本研究的目的是明确近端胃癌沿脾动脉进行淋巴结清扫的最佳手术方式。
对接受全胃切除联合胰脾切除术的近端胃癌患者进行检查。同时,对接受全胰切除术的胰腺癌患者的淋巴结解剖位置及胰腺周围转移情况进行研究。
对脾动脉周围淋巴结转移的多因素分析显示,11号淋巴结转移受10号淋巴结影响,而10号淋巴结转移可由浸润深度预测。通过Cox比例风险回归对预后变量进行多因素分析发现,10号淋巴结转移是影响预后的重要因素。在胰体或胰尾未观察到浸润胰腺实质的淋巴结转移。
保留胰腺和脾脏的全胃切除术是近端T2期胃癌的最佳手术方式。T3期病例行全胃切除联合脾切除术为宜,仅在淋巴结和/或肿瘤直接侵犯胰腺的情况下才需额外行远端胰腺切除术。