Department of Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; Department of Hepatopancreatobiliary Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; Department of Cancer Center, Methodist Dallas Medical Center, Dallas, TX, USA.
HPB (Oxford). 2014 Mar;16(3):263-6. doi: 10.1111/hpb.12111. Epub 2013 May 15.
Many previous studies have suggested that the number of lymph nodes retrieved should serve as a benchmark for assessing the adequacy of the resection. The aim was to retrospectively observe the impact of nodal retrieval after educating the pathologist.
Patients undergoing a pancreaticoduodenectomy (PD) between September 2005 and March 2009 were included in the study. The PDs performed between September 2005 and March 2008 were designated as Group A. The pathologists were educated regarding the importance of nodal counts in PD by the surgeon on the 1st April 2008. PDs performed between April 2008 and March 2009 were designated as Group B.
Ninety-eight PDs performed by a single surgeon (D.R.J.) for peri-ampullary malignancy were evaluated. The median number of lymph nodes retrieved in Group A was 11(3-32) nodes. The median number of lymph nodes retrieved in Group B was 22 (10-29) nodes (P < 0.001).The lymph node ratio (positive/total nodes), median number of positive nodes retrieved, and the node positivity (node positive compared to node negative) rate did not change.
A single intervention with the pathologists did impact the number of lymph nodes retrieved from PD specimens. However, the lymph node ratio and lymph node positivity rate remained unchanged. The pathologist is critical to nodal retrieval in PD, but the use of this lymph node number for benchmark of surgical adequacy may be simplistic.
许多先前的研究表明，淋巴结检出数量应作为评估切除充分性的基准。本研究旨在通过对病理学家进行教育来回顾性观察淋巴结检出的影响。
本研究纳入了 2005 年 9 月至 2009 年 3 月期间接受胰十二指肠切除术（PD）的患者。将 2005 年 9 月至 2008 年 3 月进行的 PD 设为 A 组。自 2008 年 4 月 1 日起，由外科医生对病理学家进行关于 PD 中淋巴结计数重要性的教育，在此之后进行的 PD 设为 B 组。
由一位外科医生（D.R.J.）进行的 98 例胰头十二指肠切除术治疗壶腹周围恶性肿瘤患者的 PD 进行了评估。A 组中淋巴结检出中位数为 11（3-32）枚，B 组为 22（10-29）枚（P<0.001）。淋巴结比率（阳性/总淋巴结）、阳性淋巴结检出中位数和淋巴结阳性率（与淋巴结阴性相比）均未发生改变。
单次干预病理学家的工作确实会影响 PD 标本中淋巴结的检出数量。然而，淋巴结比率和淋巴结阳性率保持不变。病理学家对 PD 中淋巴结的检出至关重要，但将此淋巴结数量用作手术充分性的基准可能过于简单。
