脾切除术对伴有第 10 组淋巴结转移的进展期近端胃癌的预后影响。

Prognostic impact of splenectomy on advanced proximal gastric cancer with No. 10 lymph node metastasis.

机构信息

Department of Oncology, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, China.

出版信息

Chin Med J (Engl). 2009 Nov 20;122(22):2757-62.

PMID:19951610

Abstract

BACKGROUND

This study evaluated the prognostic impact of D2 lymphadenectomy combined with splenectomy in patients with advanced proximal gastric cancer and lymph node metastasis at the splenic hilum (No. 10 lymph nodes).

METHODS

The clinical records of 216 patients with advanced proximal gastric cancer and No. 10 lymph node metastasis who underwent D2 curative resection were retrospectively analyzed. Seventy-three patients underwent simultaneous splenectomy (splenectomy group), while 143 patients did not (spleen-preserving group). Five-year survival rates, mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes, and operative morbidity and mortality were calculated and compared between the two groups. Potential prognostic factors were evaluated by univariate and multivariate analysis.

RESULTS

The 5-year survival rate was 30.0% for the splenectomy group and 19.7% for the spleen-preserving group (chi(2) = 14.73, P < 0.05). The mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes in the splenectomy group were significantly greater than in the spleen-preserving group (P < 0.05). Multivariate analysis revealed that the depth of invasion, splenectomy, and type of gastrectomy were independent prognostic factors. The survival rate for T3 patients with and without splenectomy was 38.7% and 18.9%, respectively (chi(2) = 15.03, P < 0.05). For patients undergoing total gastrectomy, survival rates were 33.4% and 20.7%, respectively (chi(2) = 13.63, P < 0.05). Operative morbidity and mortality in splenectomy group was 24.7% and 4.1%, respectively, and in the spleen-preserving group was 17.5% and 3.5%, respectively. The differences were not statistically significant (P > 0.05).

CONCLUSIONS

Splenectomy is beneficial for No. 10 lymph node dissection in patients with advanced proximal gastric cancer. To improve patient prognosis, total gastrectomy with splenectomy is recommended for patients with T3 proximal gastric cancer who have No. 10 lymph node metastasis.

摘要

背景

本研究评估了 D2 淋巴结清扫术联合脾切除术对贲门癌伴脾门（No.10 淋巴结）淋巴结转移患者的预后影响。

方法

回顾性分析 216 例接受 D2 根治性切除术的进展期近端胃癌伴 No.10 淋巴结转移患者的临床资料。73 例患者行脾切除术（脾切除组），143 例患者不行脾切除术（保脾组）。比较两组患者的 5 年生存率、No.10 淋巴结清扫数目及转移 No.10 淋巴结数目、手术并发症发生率及死亡率，并采用单因素和多因素分析评估潜在的预后因素。

结果

脾切除组 5 年生存率为 30.0%，保脾组为 19.7%（χ²=14.73，P＜0.05）。脾切除组的 No.10 淋巴结清扫数目及转移 No.10 淋巴结数目明显多于保脾组（P＜0.05）。多因素分析显示，浸润深度、脾切除术和胃切除术类型是独立的预后因素。T3 患者行脾切除术和不行脾切除术的生存率分别为 38.7%和 18.9%（χ²=15.03，P＜0.05）。全胃切除术患者的生存率分别为 33.4%和 20.7%（χ²=13.63，P＜0.05）。脾切除组手术并发症发生率和死亡率分别为 24.7%和 4.1%，保脾组分别为 17.5%和 3.5%，差异无统计学意义（P＞0.05）。