Ikeda Osamu, Sakaguchi Yoshihisa, Toh Yasushi, Oogaki Kippei, Oki Eiji, Minami Kazuhito, Okamura Takeshi, Baba Hideo
Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan.
Hepatogastroenterology. 2012 Mar-Apr;59(114):627-32. doi: 10.5754/hge10089.
BACKGROUND/AIMS: Laparoscopic distal gastrectomy (LDG) with lymphadenectomy has been revealed to be a useful treatment for early gastric cancer but oncological adequacy is controversial.
To assess the quality of lymphadenectomy, we evaluated the number of dissected lymph nodes and the non-compliance rate (defined as an absence of nodal tissue at a node station that should have been resected) and compared the data obtained from 102 patients treated by LDG with those from 90 patients treated by open distal gastrectomy (ODG).
The numbers of nodes of Categories 1 and 2, which correspond respectively to perigastric and retroperitoneal nodes, did not differ significantly between the LDG group and the ODG group. In the LDG group compared to the ODG group, there were significantly more right paracardial nodes (No. 1) but there were significantly fewer infrapyloric nodes (No. 6). However, the difference in infrapyloric nodes (No. 6) became insignificant when we re-analyzed and compared the ODG group and the patients (n=42) whose LDGs were performed by two experienced laparoscopic surgeons.
The curability of gastric cancer on LDG was almost equivalent to that of ODG from the viewpoint of lymph node dissection, if the LDG is performed by two experienced laparoscopic surgeons. These data suggested that LDG with lymphadenectomy could possibly be adopted for advanced gastric cancer treatment under proper quality control, such as that provided by an experienced laparoscopic team.
背景/目的：腹腔镜远端胃切除术（LDG）联合淋巴结清扫术已被证明是早期胃癌的一种有效治疗方法，但肿瘤学的充分性存在争议。
为评估淋巴结清扫的质量，我们评估了清扫淋巴结的数量和不符合率（定义为在应切除的淋巴结站无淋巴结组织），并将102例行LDG治疗的患者的数据与90例行开放远端胃切除术（ODG）治疗的患者的数据进行比较。
LDG组和ODG组中分别对应胃周和腹膜后淋巴结的第1和第2类淋巴结数量无显著差异。与ODG组相比，LDG组的心旁右侧淋巴结（第1组）明显更多，但幽门下淋巴结（第6组）明显更少。然而，当我们重新分析并比较ODG组和由两位经验丰富的腹腔镜外科医生进行LDG手术的患者（n = 42）时，幽门下淋巴结（第6组）的差异变得不显著。
从淋巴结清扫的角度来看，如果由两位经验丰富的腹腔镜外科医生进行LDG手术，胃癌的治愈率几乎与ODG相当。这些数据表明，在适当的质量控制下，如由经验丰富的腹腔镜团队提供的质量控制，LDG联合淋巴结清扫术可能适用于进展期胃癌的治疗。
