Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
Yonsei Med J. 2014 Jan;55(1):61-9. doi: 10.3349/ymj.2014.55.1.61.
To identify the effect of insufficient lymph node dissection (LND) on the survival of patients with pT2 gastric cancer.
A total of 340 patients (120 patients with insufficient LND and others with D2 LND) who underwent gastrectomy for pT2 gastric cancer between January 2008 and December 2010 were included.
The incidence of preoperatively diagnosed early gastric cancer was higher and there were fewer metastatic lymph nodes (LNs) in the insufficient LND group than the D2 group, but there was no survival difference between two groups (p=0.365). Among the 89 patients with metastatic LNs after D2 LND, 13 patients (14.6%) had metastatic LNs at selected N2 stations (#10, 11, or 12a), but none of these patients were in the pN1 category. One patient had five metastatic LNs at station #11p with no metastatic LNs at any other stations. The number of metastatic LNs was identified as the only risk factor for LN metastasis at selected N2 stations by logistic regression.
If a patient has pN0 or pN1 category after insufficient LND for pT2 gastric cancer, the surgery can be regarded as secure. However, for patients with pN2 or pN3 category, more careful examination is required.
确定淋巴结清扫不足（LND）对 pT2 期胃癌患者生存的影响。
纳入 2008 年 1 月至 2010 年 12 月期间接受胃切除术治疗 pT2 期胃癌的 340 例患者（120 例 LND 不足和 120 例 D2 LND）。
LND 不足组术前诊断为早期胃癌的发生率较高，转移性淋巴结（LNs）较少，但两组间生存无差异（p=0.365）。在 D2 LND 后转移性 LNs 为 89 例的患者中，有 13 例（14.6%）在选择的 N2 站（#10、11 或 12a）有转移性 LNs，但均未达到 pN1 期。有 1 例患者在站#11p 有 5 个转移性 LNs，其他任何站均无转移性 LNs。逻辑回归确定转移性 LNs 数量是选择的 N2 站发生淋巴结转移的唯一危险因素。
如果 pT2 期胃癌 LND 不足后患者为 pN0 或 pN1 期，则手术可以视为安全。但是，对于 pN2 或 pN3 期患者，需要更仔细的检查。
