Yonemura Y, Katayama K, Kamata T, Fushida S, Segawa M, Ooyama S, Miwa K, Miyazaki I
Surgery II, School of Medicine, Kanazawa University, Japan.
Int Surg. 1991 Oct-Dec;76(4):222-5.
We have studied the incidence and prognosis of N4 node (para-aortic lymph node) metastases in gastric cancer in 434 patients who had been referred to our department for surgical treatment during the period between 1978 and 1988. N4 nodal involvement was found in 76 (17.5%) of 434 patients who had received a laparotomy with resection, and in 42 (10.5%) of 400 patients who had "curative" resection. When the surgeon assessed that the patients had metastasis in para-aortic lymph nodes, the para-aortic lymph nodes lying above and below the left renal vein were completely removed (R4 gastrectomy). During this period, 42 patients with N4 nodal involvement underwent "curative" resection by R4 gastrectomy. Their treatment results were compared with those of 32 patients who underwent subtotal or total gastrectomy (R2 or R3 gastrectomy) without resection of metastases of para-aortic lymph nodes ("palliative" resection). The operating time and the operative mortality rate were similar in both groups (R4 vs R2 or R3 gastrectomy). The patients who had undergone "curative" resection (R4 gastrectomy) had a significantly higher five-year survival rate than those who had received "palliative" resection. The R4 gastrectomy is a rational and useful surgical procedure for treating patients with N4 nodal involvement.
我们研究了1978年至1988年间转诊至我科接受手术治疗的434例胃癌患者中N4淋巴结（腹主动脉旁淋巴结）转移的发生率和预后。在434例行剖腹切除手术的患者中，有76例（17.5%）发现有N4淋巴结受累；在400例行“根治性”切除的患者中，有42例（10.5%）发现有N4淋巴结受累。当外科医生评估患者存在腹主动脉旁淋巴结转移时，会将左肾静脉上下的腹主动脉旁淋巴结完全切除（R4胃切除术）。在此期间，42例N4淋巴结受累患者接受了R4胃切除术进行“根治性”切除。将他们的治疗结果与32例未切除腹主动脉旁淋巴结转移灶而接受次全或全胃切除术（R2或R3胃切除术，即“姑息性”切除）的患者的治疗结果进行了比较。两组（R4胃切除术与R2或R3胃切除术）的手术时间和手术死亡率相似。接受“根治性”切除（R4胃切除术）的患者的五年生存率明显高于接受“姑息性”切除的患者。R4胃切除术是治疗N4淋巴结受累患者的一种合理且有用的手术方法。
