Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Ann Surg Oncol. 2013 Aug;20(8):2676-82. doi: 10.1245/s10434-013-2930-9. Epub 2013 May 25.
In both advanced and early gastric cancer with preoperatively suspected lymph node metastasis, extended lymph node dissection is needed to achieve R0. Since extended lymph node dissection is difficult to perform laparoscopically, few reports have reported long-term outcomes in large numbers of patients. The purpose of this study was to investigate oncologic outcomes after laparoscopy-assisted distal gastrectomy (LADG) with extended lymph node dissection.
Between April 2004 and March 2010, LADG with extended lymph node dissection was performed at our hospital for 880 patients diagnosed with T1N0-1 or T2N0 (N is classified by Japanese topographic classification) gastric cancer in the lower or middle body of the stomach. D2 lymph node dissection was performed for stage IB (T1N1, T2N0) cancers. Modified D2 lymph node dissection was performed for stage IA (T1N0). Overall survival (OS), disease-free survival (DFS), and form of tumor recurrence at 4 years were investigated retrospectively.
Median follow-up was 42 months. The 4-year OS was 98.2 % for all patients. By stage, OS/DFS were 99.0/99.0 % in stage IA patients, 95.9/95.9 % in stage IB, 92.6/92.0 % in stage IIA, and 90.0/92.9 % in stage IIB. A total of 11 patients died, including 4 deaths from recurrence (liver metastasis, n = 1; peritoneal dissemination, n = 2; distant lymph node and bone metastases, n = 1). There is 1 patient is alive with recurrence (liver). Mean time until recurrence was 14 months.
Oncologic outcomes were good in patients with T1N0-1 and T2N0 gastric cancer who underwent LADG with extended lymph node dissection. This approach appears effective for treating T1N0-1 and T2N0 gastric cancer.
在术前疑似淋巴结转移的进展期和早期胃癌中，需要进行扩大淋巴结清扫以达到 R0。由于腹腔镜下难以进行扩大淋巴结清扫，因此很少有报告在大量患者中报告其长期结果。本研究旨在探讨腹腔镜辅助远端胃切除术（LADG）联合扩大淋巴结清扫的肿瘤学结果。
2004 年 4 月至 2010 年 3 月，我院对 880 例诊断为胃下部或中部 T1N0-1 或 T2N0（N 根据日本地形分类）的患者进行了 LADG 联合扩大淋巴结清扫。对于 IB 期（T1N1，T2N0）癌症进行 D2 淋巴结清扫。对于 IA 期（T1N0）患者进行改良 D2 淋巴结清扫。回顾性调查了 4 年的总生存率（OS）、无病生存率（DFS）和肿瘤复发形式。
中位随访时间为 42 个月。所有患者的 4 年 OS 为 98.2%。按分期，IA 期患者的 OS/DFS 分别为 99.0/99.0%，IB 期为 95.9/95.9%，IIA 期为 92.6/92.0%，IIB 期为 90.0/92.9%。共有 11 例患者死亡，其中 4 例死于复发（肝转移 1 例，腹膜播散 2 例，远处淋巴结和骨转移 1 例）。有 1 例患者仍存活且有复发（肝）。复发的平均时间为 14 个月。
对于接受 LADG 联合扩大淋巴结清扫的 T1N0-1 和 T2N0 胃癌患者，肿瘤学结果良好。该方法似乎对治疗 T1N0-1 和 T2N0 胃癌有效。
