Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Ann Surg Oncol. 2013 Jan;20(1):218-25. doi: 10.1245/s10434-012-2544-7. Epub 2012 Aug 1.
To assess the efficacy of extended lymph node dissection in gastric cancer and to identify factors affecting lymph node detection.
A prospective study of 126 gastric cancer patients was conducted. Patients eligible for curative resection received total gastrectomy and extended lymphadenectomy (D2) and paraaortic lymph node sampling as the standard of care (study group). Supramesocolic total lymphadenectomy of the upper gastrointestinal tract was performed on 23 autopsy cases as a control group.
Fifty-five gastric carcinoma patients were included in the study group. Median age was 58 years (range 31-80 years); 14 patients were female (25%), and 41 were male (75%). The median number of lymph nodes harvested from the specimen was 47 (24-95), and the median number of metastatic lymph nodes was 15 (1-71). In contrast, in the autopsy comparative group, the median number of harvested lymph nodes was 72 (50-91). The median number of stational lymph nodes excised (lymph nodes excised from stations 4, 5, 10, 11, 12, and 16) was significantly higher in the control group than in the study group (P<0.05). Lymph node detection was adversely affected by body mass index (BMI) (P<0.03). In the study group, stations 5, 12, 11, and 10 had the highest lymph node absence (LNA) (noncompliance) ratio with percentages of 53, 36, 33, and 22%, respectively. In the autopsy group, LNA (noncompliance) was not detected.
Lymph nodes should be dissected by surgeons with sufficient technical and anatomical experience, and then examined and counted by experienced pathologists to reduce the occurrence of LNA. The results of this anatomical study can serve as a guideline to assess the success of lymph node dissection during gastric cancer surgery. Similar studies should be conducted in every country to establish national guidelines.
评估胃癌扩大淋巴结清扫术的疗效，并确定影响淋巴结检出的因素。
对 126 例胃癌患者进行前瞻性研究。符合根治性切除条件的患者接受全胃切除术和扩大淋巴结清扫术（D2）以及主动脉旁淋巴结取样作为标准治疗（研究组）。23 例尸检病例行上消化道胃系膜切除术作为对照组。
研究组纳入 55 例胃癌患者。中位年龄为 58 岁（范围 31-80 岁）；14 例女性（25%），41 例男性（75%）。标本中采集的淋巴结中位数为 47 个（24-95 个），转移性淋巴结中位数为 15 个（1-71 个）。相比之下，在尸检对照组中，采集的淋巴结中位数为 72 个（50-91 个）。对照组中切除的站淋巴结（从站 4、5、10、11、12 和 16 切除的淋巴结）数量明显高于研究组（P<0.05）。体重指数（BMI）对淋巴结检测有不利影响（P<0.03）。在研究组中，站 5、12、11 和 10 的淋巴结缺失（不依从）比例最高，分别为 53%、36%、33%和 22%。在尸检组中，未发现淋巴结缺失（不依从）。
淋巴结应由具有足够技术和解剖经验的外科医生进行解剖，然后由经验丰富的病理学家进行检查和计数，以减少淋巴结缺失的发生。本解剖研究的结果可作为评估胃癌手术中淋巴结清扫术成功的指南。每个国家都应开展类似的研究，制定国家指南。
