Cichowitz Adam, Burton Paul, Brown Wendy, Smith Andrew, Shaw Kalai, Slamowicz Ron, Nottle Peter D
Department of General Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2015 Jan;85(1-2):80-4. doi: 10.1111/ans.12365. Epub 2013 Aug 26.
Retrieval and analysis of an adequate number of lymph nodes is critical for accurate staging of oesophageal and gastric cancer. Higher total node counts reported by pathologists are associated with improved survival. A prospective study was undertaken to understand the factors contributing to variability in lymph node counts after oesophagogastric cancer resections and to determine whether a novel strategy of ex vivo dissection of resected specimens into nodal stations improves node counts reported by pathologists.
The study involved 88 patients with potentially curable oesophagogastric cancer undergoing radical resection. Lymph node counts were obtained from pathology reports and analysed in relation to multiple variables including the introduction of ex vivo dissection of nodal stations in theatre.
Higher lymph node counts were obtained with ex vivo dissection of nodal stations (median 19 versus 8, P < 0.01). Node counts also varied significantly with the reporting pathologist (median range 4 to 48, P = 0.02) which was independent of the level of experience of the pathologist (P = 0.67). Node counts were not affected by patient age (P = 0.26), gender (P = 0.50), operative approach (P = 0.50) or neoadjuvant therapy (P = 0.83).
Specimen handling is a significant factor in determining lymph node yield following radical oesophageal and gastric cancer resections. Ex vivo dissection of resected specimens into nodal stations improves node counts without alterations to surgical techniques. Ex vivo dissection should be considered routine.
获取并分析足够数量的淋巴结对于食管癌和胃癌的准确分期至关重要。病理学家报告的更高的淋巴结总数与生存率提高相关。开展了一项前瞻性研究，以了解影响食管癌和胃癌切除术后淋巴结计数变异性的因素，并确定将切除标本进行体外分站解剖的新策略是否能提高病理学家报告的淋巴结计数。
该研究纳入了88例接受根治性切除的潜在可治愈的食管癌和胃癌患者。从病理报告中获取淋巴结计数，并分析其与多个变量的关系，包括术中引入体外分站解剖。
采用体外分站解剖获得的淋巴结计数更高（中位数分别为19个和8个，P < 0.01）。淋巴结计数在不同的报告病理学家之间也有显著差异（中位数范围为4至48个，P = 0.02），这与病理学家的经验水平无关（P = 0.67）。淋巴结计数不受患者年龄（P = 0.26）、性别（P = 0.50）、手术方式（P = 0.50）或新辅助治疗（P = 0.83）的影响。
标本处理是决定食管癌和胃癌根治性切除术后淋巴结收获量的一个重要因素。将切除标本进行体外分站解剖可提高淋巴结计数，且无需改变手术技术。体外解剖应被视为常规操作。
