Department of Surgery, Klinikum Nürnberg, Prof. Ernst-Nathan Str. 1, 90419, Nuremberg, Germany.
J Gastrointest Surg. 2013 Apr;17(4):611-8; discussion 618-9. doi: 10.1007/s11605-013-2146-0. Epub 2013 Jan 24.
The value of lymphadenectomy in most localized gastrointestinal (GI) malignancies is well established. Our objectives were to evaluate the time trends of lymphadenectomy in GI cancer and identify factors associated with inadequate lymphadenectomy in a large population-based sample.
Using the National Cancer Institute's Surveillance Epidemiology and End Results Database (1998-2009), a total of 326,243 patients with surgically treated GI malignancy (esophagus, 13,165; stomach, 18,858; small bowel, 7,666; colon, 232,345; rectum, 42,338; pancreas, 12,141) were identified. Adequate lymphadenectomy was defined based on the National Cancer Center Network's recommendations as more than 15 esophagus, 15 stomach, 12 small bowel, 12 colon, 12 rectum, and 15 pancreas. The median number of lymph nodes removed and the prevalence of adequate and/or no lymphadenectomy for each cancer type were assessed and trended over the ten study years. Multivariate logistic regression was employed to identify factors predicting adequate lymphadenectomy.
The median number of excised nodes improved over the decade of study in all types of cancer: esophagus, from 7 to 13; stomach, 8-12; small bowel, 2-7; colon, 9-16; rectum, 8-13; and pancreas, 7-13. Furthermore, the percentage of patients with an adequate lymphadenectomy (49 % for all types) steadily increased, and those with zero nodes removed (6 % for all types) steadily decreased in all types of cancer, although both remained far from ideal. By 2009, the percentages of patients with adequate lymphadenectomy were 43 % for esophagus, 42 % for stomach, 35 % for small intestine, 77 % for colon, 61 % for rectum, and 42 % for pancreas. Men, patients >65 years old, or those undergoing surgical therapy earlier in the study period and living in areas with high poverty rates were significantly less likely to receive adequate lymphadenectomy (all p < 0.0001).
Lymph node retrieval during surgery for GI cancer remains inadequate in a large proportion of patients in the USA, although the median number of resected nodes increased over the last 10 years. Gender and socioeconomic disparities in receiving adequate lymphadenectomy were observed.
在大多数局部胃肠道（GI）恶性肿瘤中，淋巴结切除术的价值已得到充分证实。我们的目的是评估 GI 癌症中淋巴结切除术的时间趋势，并在大样本人群中确定与淋巴结切除术不足相关的因素。
使用美国国家癌症研究所的监测、流行病学和最终结果数据库（1998-2009 年），共确定了 326243 例接受手术治疗的胃肠道恶性肿瘤（食管 13165 例；胃 18858 例；小肠 7666 例；结肠 232345 例；直肠 42338 例；胰腺 12141 例）。根据国家癌症中心网络的建议，将足够的淋巴结切除术定义为切除超过 15 个食管、15 个胃、12 个小肠、12 个结肠、12 个直肠和 15 个胰腺的淋巴结。评估并分析了每种癌症类型的中位数淋巴结切除数以及足够和/或无淋巴结切除术的流行率，并在 10 年研究期间进行了趋势分析。采用多变量逻辑回归分析确定预测淋巴结切除术的因素。
在研究的十年中，所有类型癌症的切除淋巴结中位数均有所增加：食管，从 7 增加到 13；胃，从 8 增加到 12；小肠，从 2 增加到 7；结肠，从 9 增加到 16；直肠，从 8 增加到 13；胰腺，从 7 增加到 13。此外，所有类型癌症中，足够淋巴结切除术的患者比例（所有类型为 49%）稳步上升，而所有类型中零淋巴结切除的患者比例（所有类型为 6%）稳步下降，但两者均远不理想。到 2009 年，食管的淋巴结切除术比例为 43%，胃为 42%，小肠为 35%，结肠为 77%，直肠为 61%，胰腺为 42%。男性、年龄>65 岁、研究早期接受手术治疗以及生活在贫困率较高地区的患者接受足够的淋巴结切除术的可能性显著降低（均 p<0.0001）。
在美国，尽管过去 10 年来切除的淋巴结中位数有所增加，但胃肠道癌症手术中淋巴结的获取仍然不足，在很大比例的患者中仍然不足。观察到在接受足够的淋巴结切除术方面存在性别和社会经济差异。
