Roviello Franco, Marrelli Daniele, Morgagni Paolo, De Manzoni Giovanni, Di Leo Alberto, Vindigni Carla, Nastri Giacomo, Saragoni Luca, Tomezzoli Anna, Kurihara Hayato, De Stefano Alfonso
U.O. Chirurgia Oncologica Dipartimento di Patologia Umana e Oncologia, Università di Siena.
Chir Ital. 2003 Jul-Aug;55(4):491-8.
The actual benefit of extended lymphadenectomy in terms of survival in the surgical treatment of gastric cancer is still a debated issue. The aim of this non-randomized prospective multicentre study was to evaluate long-term survival in a group of patients with involvement of the second level lymph nodes, which would not have been removed with a limited lymphadenectomy. From 1991 to 1997, 451 patients with primary gastric cancer underwent curative resection with extended lymphadenectomy in three italian surgical departments. Lymph node stations were removed and classified according to the rules of the Japanese Research Society for Gastric Cancer; in all cases, retrieval of the lymph nodes was performed by the surgeon on the fresh specimen. Metastases to lymph node stations 7-12 were found in 126 patients out of 451 (27.9%). A mean number of 13 +/- 9 positive lymph nodes (range: 1-42) was found in these cases. Lymph node stations 7 and 8 showed the highest incidence of metastases (61.1% and 44.4%, respectively). Morbidity and mortality rates were 17.1% and 2% in 451 cases treated by extended lymphadenectomy, and 21.4% and 3.2%, respectively, in 126 cases with involvement of second level lymph nodes. In this group of patients, the five-year survival rate was 32 +/- 4%. Multivariate analysis, identified depth of invasion (P < 0.0001, relative risk (RR) 2.4) and the number of positive lymph nodes (P < 0.001, RR 1.6) as significant predictors of a poor prognosis. Japanese-type extended lymphadenectomy is associated with low morbidity and mortality rates if performed in specialised centres. The incidence of metastases in lymph node stations removed with this technique is by no means negligible. This procedure could be beneficial as regards long-term survival even in patients with involvement of regional lymph nodes.
在胃癌外科治疗中，扩大淋巴结清扫术对生存的实际益处仍是一个有争议的问题。这项非随机前瞻性多中心研究的目的是评估一组二级淋巴结受累患者的长期生存情况，这些患者若采用有限淋巴结清扫术则无法清除这些淋巴结。1991年至1997年，意大利三个外科科室的451例原发性胃癌患者接受了扩大淋巴结清扫术的根治性切除。根据日本胃癌研究学会的规则切除并分类淋巴结站；在所有病例中，外科医生在新鲜标本上进行淋巴结的摘取。451例患者中有126例（27.9%）发现有第7 - 12组淋巴结转移。这些病例中平均有13±9个阳性淋巴结（范围：1 - 42个）。第7组和第8组淋巴结转移发生率最高（分别为61.1%和44.4%）。扩大淋巴结清扫术治疗的451例患者的发病率和死亡率分别为17.1%和2%，二级淋巴结受累的126例患者的发病率和死亡率分别为21.4%和3.2%。在这组患者中，五年生存率为32±4%。多变量分析确定浸润深度（P < 0.0001，相对危险度（RR）2.4）和阳性淋巴结数量（P < 0.001，RR 1.6）是预后不良的重要预测因素。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。用这种技术切除的淋巴结站中的转移发生率绝不可忽略。即使对于区域淋巴结受累的患者，该手术在长期生存方面可能也是有益的。
