Dias Andre Roncon, Pereira Marina Alessandra, Mello Evandro Sobroza, Zilberstein Bruno, Cecconello Ivan, Ribeiro Junior Ulysses
São Paulo State Cancer Institute, University of São Paulo, São Paulo, SP, 01410-000, Brazil.
, Alameda Ministro Rocha Azevedo, 644. ap 161, São Paulo, Brazil.
Gastric Cancer. 2016 Jan;19(1):136-42. doi: 10.1007/s10120-014-0443-2. Epub 2014 Nov 20.
Pathological examination of a minimum of 16 lymph nodes is recommended following surgery for gastric adenocarcinoma, despite this a longer survival is expected when 30 or more lymph nodes are examined. Small lymph nodes are difficult to identify, and fat-clearing solutions have been proposed to improve this, but there is no evidence of their clinical benefit.
Fifty D2 subtotal gastrectomy specimens were randomized for fixation in Carnoy's solution (CS) or 10% neutral buffered formalin (NBF), with subsequent fat dissection. After dissection, the residual fat from the NBF group, instead of being discarded, was immersed in CS and dissected again. Data from 25 D2 subtotal gastrectomies performed before the study were also analyzed.
The mean number of examined lymph nodes was 50.4 and 34.8 for CS and NBF, respectively (p < 0.001). Missing lymph nodes were found in all cases from the residual fat group (mean of 16.9), and in eight of them (32%) metastatic lymph nodes were present; this allowed the upstaging of two patients. Lymph nodes in the CS group were smaller than those in the NBF group (p = 0.01). The number of retrieved lymph nodes was similar among the NBF and Retrospective groups (p = 0.802).
Compared with NBF, CS increases lymph node detection following gastrectomy and allows a more accurate pathological staging. No influence of the research protocol on the number of examined lymph nodes was observed.
尽管建议对胃腺癌患者术后至少检查16枚淋巴结，但检查30枚或更多淋巴结时预期生存期更长。小淋巴结难以识别，有人提出使用脂肪清除液来改善这一情况，但尚无证据表明其具有临床益处。
50例D2次全胃切除标本被随机分组，分别用卡诺氏液（CS）或10%中性缓冲福尔马林（NBF）固定，随后进行脂肪清除。清除后，NBF组的残余脂肪不丢弃，而是浸入CS中再次进行清除。还分析了研究前进行的25例D2次全胃切除术的数据。
CS组和NBF组检查的淋巴结平均数量分别为50.4枚和34.8枚（p<0.001）。在残余脂肪组的所有病例中均发现有遗漏淋巴结（平均16.9枚），其中8例（32%）存在转移淋巴结；这使得两名患者的分期得以提高。CS组的淋巴结比NBF组的小（p=0.01）。NBF组和回顾性组之间回收的淋巴结数量相似（p=0.802）。
与NBF相比，CS可增加胃切除术后淋巴结的检出数量，并能实现更准确的病理分期。未观察到研究方案对检查淋巴结数量的影响。
