1st Department of Surgery, University of Athens, Medical School, LAIKO Hospital, Athens, Greece.
World J Gastroenterol. 2009 Nov 28;15(44):5568-72. doi: 10.3748/wjg.15.5568.
To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemically detected skip micrometastases in level II lymph nodes.
Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0. All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the level I lymph node stations (n = 4) were excluded from further analysis. The level II lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study.
Skip micrometastases in the level II lymph nodes were detected in 14% (4 out of 28) of the patients. The incidence was further increased to 17% (4 out of 24) in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No. 7 lymph node station. Thus, the disease was upstaged from stage IA to IB in one patient and from stage IB to II in three patients.
In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.
评估基于免疫组化检测到的 II 区淋巴结微转移的常规改良 D2 淋巴结清扫术在胃癌中的作用。
2004 年 1 月至 2008 年 12 月，95 例胃癌患者常规接受根治性改良 D2 淋巴结清扫术，其中 32 例患者 pN0 分期。对这 32 例患者的所有 I 区淋巴结进行免疫组化微转移检测。在 I 区淋巴结站检测到微转移的 4 例患者（n=4）被排除在进一步分析之外。其余 28 例患者的 II 区淋巴结进行免疫组化微转移检测，构成本研究的材料。
28 例患者中有 14%（4 例）存在 II 区淋巴结微转移。在 T1-2 期胃癌患者亚组中，微转移的发生率进一步增加至 17%（4 例）。所有微转移均在 7 号淋巴结站检测到。因此，1 例患者从 IA 期升级为 IB 期，3 例患者从 IB 期升级为 II 期。
在胃癌中，如果不进行改良 D2 淋巴结清扫术，可能无法实现真正的 R0 切除。在 D2+/D3 淋巴结清扫术成为标准之前，应常规进行改良 D2 淋巴结清扫术。
