First Department of Surgery and Pathology Department, University of Athens, Medical School, Laiko Hospital, Athens, Greece.
Scand J Surg. 2011;100(3):174-80. doi: 10.1177/145749691110000307.
Topographic correlation between the primary gastric tumor and the first peri- and extragastric lymphatic drain basin (solitary lymph node metastasis) on gastrectomy specimens, represents a reliable method to investigate and understand the exact pattern of lymphatic drainage from a gastric tumor. Analyzing that correlation, useful information regarding the extent of the appropriate oncological perigastric lymphadenectomy will be provided. We retrospectively evaluate the usefulness of a modified D2 lymphadenectomy in gastric cancer patients, based on the topographic correlation between the primary tumor and the location of the solitary lymph node metastases, as they were detected by histology and immunohistochemistry.
Between April 2003 and March 2010, 134 gastric cancer patients were submitted to a modified D2 lymphadenectomy. Postoperatively, the standard histological ex-amination by hematoxylin and eosin (HE) staining, disclosed metastatic infiltration of at least two lymph nodes in 90 patients, solitary lymph node metastases were histologically detected in 10 patients, while the remaining 34 patients were classified as pN0. All lymph nodes of the ten patients with histological solitary lymph node metastases, as well as the 34 patients who had been classified as pN0 by histology, were further submitted to immunohistochemistry for micrometastases detection. More than one micrometastases were detected in none of them, while in seven patients solitary micrometastases were detected either in the level I perigastric or in the level II extragastric lymph nodes stations (skip micrometastases).
Solitary lymph node metastases were detected by histology in ten patients and by immunohistochemistry in additional seven (nine females and eight males). Solitary metastases were detected in the level I LN stations in seven patients (four by histology and three by immunohistochemistry) and in the level II LN stations in ten patients (six by histology and four by immunohistochemistry). In order of frequency, the solitary lymph node metastases were located in the no 7 (n = 6), no 6 (n = 4), no 9 (n = 2), no 5 (n = 2), no 4 (n = 1), no 8 (n = 1) and no 12 (n = 1) LN stations. Skip metastases encountered the 60% of the histologically detected, 57% of the immunohistochemically detected and 59% of all solitary lymph node metastases. 80% of solitary metastases in the level II LN stations, were mainly located in the nos 7-9 lymph node stations complex. Tumors of the lower and middle-third of the stomach were equally drained both to the level I and level II lymph node stations, while 67% of the tumors towards the lesser curvature, were mainly drained in the level II lymph node stations.
D2 lymphadenectomy increases the number of true R0 resections. Thus, a modified D2 lymphadenectomy should be routinely performed in gastric cancer patients.
胃切除标本上原发性胃肿瘤与第一周围和外部胃淋巴引流区（孤立淋巴结转移）之间的地形相关性，代表了研究和了解胃肿瘤淋巴引流的确切模式的可靠方法。分析这种相关性，可以提供有关适当的胃癌围胃淋巴结清扫术范围的有用信息。我们回顾性评估了基于原发性肿瘤与孤立淋巴结转移位置之间的地形相关性，对 134 例胃癌患者进行改良 D2 淋巴结清扫术的有效性，这些相关性是通过组织学和免疫组织化学检测到的。
2003 年 4 月至 2010 年 3 月，对 134 例胃癌患者进行了改良 D2 淋巴结清扫术。术后，通过苏木精和伊红（HE）染色的标准组织学检查，在 90 例患者中发现至少两个淋巴结转移浸润，10 例患者中发现孤立淋巴结转移，而其余 34 例患者被归类为 pN0。所有 10 例组织学上有孤立淋巴结转移的患者的淋巴结，以及 34 例组织学上被归类为 pN0 的患者的淋巴结，均进一步进行免疫组织化学检测以检测微转移。在这些患者中，没有一个患者发现超过一个微转移，而在 7 例患者中，在胃周 I 级或胃外 II 级淋巴结站（跳跃微转移）中发现了孤立的微转移。
组织学上发现 10 例患者存在孤立淋巴结转移，免疫组织化学上发现另外 7 例患者存在孤立淋巴结转移（9 例女性，8 例男性）。在 7 例患者中（4 例通过组织学，3 例通过免疫组织化学）发现孤立转移位于 I 级 LN 站，在 10 例患者中（6 例通过组织学，4 例通过免疫组织化学）发现孤立转移位于 II 级 LN 站。孤立淋巴结转移最常位于第 7 号（n = 6）、第 6 号（n = 4）、第 9 号（n = 2）、第 5 号（n = 2）、第 4 号（n = 1）、第 8 号（n = 1）和第 12 号（n = 1）LN 站。跳跃转移占组织学检测到的转移的 60%、免疫组织化学检测到的转移的 57%和所有孤立淋巴结转移的 59%。在 II 级 LN 站发现的孤立转移中，80%主要位于第 7-9 号淋巴结站复合体。胃中下三分之一的肿瘤同样引流至 I 级和 II 级淋巴结站，而向小弯侧的 67%肿瘤主要引流至 II 级淋巴结站。
D2 淋巴结清扫术增加了真正 R0 切除的数量。因此，胃癌患者应常规进行改良 D2 淋巴结清扫术。
