Kunisaki Chikara, Shimada Hiroshi, Nomura Masato, Matsuda Goro, Otsuka Yuichi, Ono Hidetaka, Akiyama Hirotoshi
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura Kanazawa-ku, Yokohama, 236-0004, Japan.
Hepatogastroenterology. 2006 May-Jun;53(69):468-72.
BACKGROUND/AIMS: In gastric cancer, appropriate lymph node dissection increases survival, and hence it is of value to determine lymph node metastasis distribution in the early phase of progression.
This study involved a series of 274 consecutive patients with 1-6 lymph node metastases occurring after resection. The pattern of lymph node metastases was analyzed retrospectively.
Of 102 patients with single lymph node metastasis, over 60% of metastases occurred in specific lymph nodes for each tumor. However, the remainder was scattered in an unpredictable manner including the para-aortic lymph nodes. Despite variations in invasiveness of tumors in patients with a single lymph node, the distribution remained unchanged. Nor was there any change in patients with an increased number of metastatic lymph nodes. However, in the latter group a higher proportion of metastases were widespread. About 85-90% of node was located within paragastric lymph nodes.
Over 60% of metastatic lymph nodes would be eliminated by the dissection of specific areas determined by the site of the tumor. If the concept of sentinel lymph nodes in gastric cancer is valid, navigation surgery will be necessary for patients with early gastric cancer to locate such unpredictable metastasis.
背景/目的：在胃癌中，恰当的淋巴结清扫可提高生存率，因此在疾病进展早期确定淋巴结转移分布具有重要意义。
本研究纳入了一系列274例连续的患者，这些患者在切除术后出现1 - 6个淋巴结转移。对淋巴结转移模式进行回顾性分析。
在102例单个淋巴结转移的患者中，超过60%的转移发生在每个肿瘤对应的特定淋巴结。然而，其余转移则以不可预测的方式散布，包括主动脉旁淋巴结。尽管单个淋巴结转移患者的肿瘤侵袭性存在差异，但转移分布保持不变。转移淋巴结数量增加的患者也没有变化。然而，在后一组中，转移扩散的比例更高。约85 - 90%的淋巴结位于胃周淋巴结内。
通过清扫由肿瘤部位确定的特定区域，可清除超过60%的转移淋巴结。如果胃癌前哨淋巴结的概念成立，早期胃癌患者进行导航手术对于定位这种不可预测的转移是必要的。
