Division of Gastrointestinal Surgery, Department of Surgery, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
Ann Surg Oncol. 2013 Oct;20(11):3534-40. doi: 10.1245/s10434-013-3124-1. Epub 2013 Jul 12.
Laparoscopic gastrectomy is usually indicated in T1 N0-1 early gastric cancer (EGC). Limited lymph node dissection, such as D1+, is applied in these cases. However, preoperative staging is not always correct, and the risk of undertreatment thus exists.
Patients with clinically early gastric cancer (cEGC) who underwent gastrectomy with lymph node dissection of D2 and over were selected from 4,021 patients with gastric cancer. The station numbers of all metastatic lymph nodes (MLNs) were identified, and MLNs were classified into groups 1 and 2 (including lymph nodes of second tier and over) on the basis of the system of the Japanese Gastric Cancer Association, irrespective of the number of MLNs. Clinicopathological data were compared according to the existence of lymph node metastasis and the classification of MLNs.
Of 1,308 patients with cEGC who fulfilled the inclusion criteria, 1,184 (90.5 %) were diagnosed pathologically with EGC. Among 126 patients with cEGC who were diagnosed with lymph node metastasis, 93 patients had only group 1 MLNs and 33 patients had group 2 MLNs. Tumor location in the proximal third of the stomach (odds ratio 5.450) and ulceration (odds ratio 11.928) were significant factors for group 2 metastasis.
Extended lymph node dissection is recommended in cEGC with ulceration or disease located in the proximal third of the stomach.
腹腔镜胃切除术通常适用于 T1N0-1 期早期胃癌（EGC）。在这些病例中应用了有限的淋巴结清扫术，如 D1+。然而，术前分期并不总是正确的，因此存在治疗不足的风险。
从 4021 例胃癌患者中选择接受 D2 及以上淋巴结清扫术的临床早期胃癌（cEGC）患者。确定所有转移淋巴结（MLNs）的站数，并根据日本胃癌协会的系统将 MLNs 分为 1 组和 2 组（包括二级及以上的淋巴结），无论 MLN 的数量如何。根据淋巴结转移的存在和 MLN 的分类比较临床病理数据。
在符合纳入标准的 1308 例 cEGC 患者中，1184 例（90.5%）病理诊断为 EGC。在 126 例 cEGC 患者中诊断为淋巴结转移的患者中，93 例仅存在 1 组 MLN，33 例存在 2 组 MLN。胃近端三分之一的肿瘤位置（优势比 5.450）和溃疡（优势比 11.928）是 2 组转移的显著因素。
对于溃疡或位于胃近端三分之一的 cEGC ，建议进行扩展淋巴结清扫术。
