Li C, Kim S, Lai J F, Oh S J, Hyung W J, Choi W H, Choi S H, Zhu Z G, Noh S H
Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.
Eur J Surg Oncol. 2009 Jul;35(7):709-14. doi: 10.1016/j.ejso.2008.03.011. Epub 2008 May 5.
To evaluate the clinicopathological factors influencing lymph node metastasis around the splenic artery and hilum and the effect of spleen-preserved lymphadenectomy in advanced middle third gastric carcinoma.
We retrospectively studied 131 patients with advanced middle third gastric carcinoma who had received D2 lymphadenectomy and lymph node dissection around the splenic artery and hilum, from 2000 to 2004. Of these patients, 62 simultaneously underwent splenectomy and 69 underwent spleen-preserved lymphadenectomy.
The incidences of Nos. 10 and 11 lymph node metastases were 21% and 15%, respectively, in advanced middle third gastric carcinoma. A tumor size larger than 5 cm, metastases of Nos. 1 and 7-9 lymph node were independent risk factors for metastasis of No. 10 and/or No. 11 lymph node. The spleen-preserved group had a slightly better survival rate and a relatively lower rate of postoperative complications than the splenectomy group. No. 10 and/or No. 11 lymph node metastasis was an independent prognostic factor, while splenectomy was not.
It is necessary to remove the lymph nodes around the splenic artery and hilum to achieve radical resection in advanced middle third gastric carcinoma patients with risk factors. Our results demonstrate that spleen-preserved lymphadenectomy is a good option for those patients.
评估影响脾动脉和脾门周围淋巴结转移的临床病理因素以及保留脾脏的淋巴结清扫术在进展期胃中上部癌中的效果。
我们回顾性研究了2000年至2004年间接受D2淋巴结清扫术及脾动脉和脾门周围淋巴结清扫的131例进展期胃中上部癌患者。其中，62例同时接受了脾切除术，69例接受了保留脾脏的淋巴结清扫术。
进展期胃中上部癌中，第10和第11组淋巴结转移率分别为21%和15%。肿瘤大小大于5 cm、第1组和第7 - 9组淋巴结转移是第10和/或第11组淋巴结转移的独立危险因素。保留脾脏组的生存率略高于脾切除组，术后并发症发生率相对较低。第10和/或第11组淋巴结转移是独立的预后因素，而脾切除术不是。
对于有危险因素的进展期胃中上部癌患者，为实现根治性切除，有必要清扫脾动脉和脾门周围的淋巴结。我们的结果表明，保留脾脏的淋巴结清扫术对这些患者是一个不错的选择。
