全胃切除及脾切除术后胃癌患者脾门淋巴结转移的预后
Prognosis of metastatic splenic hilum lymph node in patients with gastric cancer after total gastrectomy and splenectomy.
作者信息
Aoyagi Keishiro, Kouhuji Kikuo, Miyagi Motoshi, Imaizumi Takuya, Kizaki Junya, Shirouzu Kazuo
机构信息
Keishiro Aoyagi, Kikuo Kouhuji, Motoshi Miyagi, Takuya Imaizumi, Junya Kizaki, Kazuo Shirouzu, Department of Surgery, Kurume University School of Medicine, Fukuoka 830-0011, Japan.
出版信息
World J Hepatol. 2010 Feb 27;2(2):81-6. doi: 10.4254/wjh.v2.i2.81.
AIM
To clarify the significance of combined resection of the spleen to dissect the No. 10 lymph node (LN).
METHODS
We studied 191 patients who had undergone total gastrectomy with splenectomy, excluding non-curative cases, resection of multiple gastric cancer, and those with remnant stomach cancer. Various clinicopathological factors were evaluated for any independent contributions to No. 10 LN metastasis, using χ(2) test. Significant factors were extracted for further analysis, carried out using a logistic regression method. Furthermore, lymph node metastasis was evaluated for any independent contribution to No. 10 LN metastasis, using the same methods. The cumulative survival rate was calculated using the Kaplan-Meier method. The significance of any difference between the survival curves was determined using the Cox-Mantel test, and any difference was considered significant at the 5% level.
RESULTS
From the variables considered to be potentially associated with No. 10 LN metastasis, age, depth, invasion of lymph vessel, N factor, the number of lymph node metastasis, Stage, the number of sites, and location were found to differ significantly between those with metastasis (the Positive Group) and those without (the Negative Group). A logistic regression analysis showed that the localization and Stage were significant parameters for No. 10 LN metastasis. There was no case located on the lesser curvature in the Positive Group. The numbers of No. 2, No. 3, No. 4sa, No. 4sb, No. 4d, No. 7, and No. 11 LN metastasis were each found to differ significantly between the Positive Group and the Negative Group. A logistic regression analysis showed that No. 4sa, No. 4sb, and No. 11 LN metastasis were each a significant parameter for No. 10 LN metastasis. There was no significant difference in survival curves between the Positive Group and the Negative Group.
CONCLUSION
Splenectomy should be performed to dissect No. 10 LN for cases which have No. 4sa, No. 4sb or No. 11 LN metastasis. However, in cases where the tumor is located on the lesser curvature, splenectomy can be omitted.
目的
阐明联合脾脏切除以清扫第10组淋巴结（LN）的意义。
方法
我们研究了191例行全胃切除并脾切除的患者，排除非根治性病例、多原发性胃癌及残胃癌患者。采用χ²检验评估各种临床病理因素对第10组LN转移的独立影响。提取显著因素进行进一步分析，采用逻辑回归方法。此外，采用相同方法评估淋巴结转移对第10组LN转移的独立影响。采用Kaplan-Meier法计算累积生存率。使用Cox-Mantel检验确定生存曲线之间差异的显著性，差异在5%水平被认为具有显著性。
结果
在被认为可能与第10组LN转移相关的变量中，年龄、深度、淋巴管浸润、N因子、淋巴结转移数量、分期、部位数量和位置在有转移组（阳性组）和无转移组（阴性组）之间存在显著差异。逻辑回归分析显示，定位和分期是第10组LN转移的显著参数。阳性组中无位于胃小弯的病例。第2、3、4sa、4sb、4d、7和11组LN转移数量在阳性组和阴性组之间均存在显著差异。逻辑回归分析显示，4sa、4sb和11组LN转移各自是第10组LN转移的显著参数。阳性组和阴性组生存曲线之间无显著差异。
结论
对于有4sa、4sb或11组LN转移的病例，应行脾切除以清扫第10组LN。然而，对于肿瘤位于胃小弯的病例，可省略脾切除。
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