Bian Shibo, Xi Hongqing, Wu Xiaosong, Cui Jianxin, Ma Liangang, Chen Rong, Wei Bo, Chen Lin
Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
J Gastrointest Surg. 2016 Jul;20(7):1295-304. doi: 10.1007/s11605-016-3113-3. Epub 2016 Mar 3.
There is no consensus in the impact of No. 10 lymph node dissection (LND) for advanced proximal gastric cancer (APGC) and the status of negative No. 4sa and No. 4sb lymph nodes (No. 4s LNs) is reportedly associated with no metastasis to No. 10 LN. We aimed to evaluate the role of No. 10 LND in APGC patients with negative No. 4s LNs and the diagnostic accuracy of intraoperative pathologic examination.
We analyzed data on 727 patients with APGC who had undergone D2 lymphadenectomy with No. 10 LND (n = 380) or without No. 10 LND (n = 347) between January 2005 and December 2010. Additionally, from January to July 2014, we prospectively enrolled 48 patients with APGC and examined their No. 4s LNs intraoperatively.
The negative predictive efficacy of No. 4s LN status for no metastasis to No. 10 LN was 98.09 %. Operation time, blood loss, time to first solid diet, hospital stay, and postoperative complication rate differed significantly between patients with negative No. 4s LNs who underwent No. 10 LND (n = 260) and those who did not undergo No. 10 LND (n = 243). Differences between the two groups in 5-year overall and disease-free survival were not statistically significant. The sensitivity, specificity, and accuracy of intraoperative pathological examination of LNs were 93.42, 96.56, and 95.86 %, respectively.
The No. 10 lymphadenectomy may not be recommended in patients with APGC who are found by intraoperative pathological examination to have negative No. 4s LNs.
对于进展期近端胃癌（APGC）行第10组淋巴结清扫（LND）的影响尚无共识，据报道第4sa和第4sb组淋巴结（第4s组LN）阴性与第10组LN无转移相关。我们旨在评估第10组LND在第4s组LN阴性的APGC患者中的作用以及术中病理检查的诊断准确性。
我们分析了2005年1月至2010年12月期间727例行D2淋巴结清扫术的APGC患者的数据，其中380例行第10组LND，347例未行第10组LND。此外，2014年1月至7月，我们前瞻性纳入了48例APGC患者并在术中检查其第4s组LN。
第4s组LN状态对第10组LN无转移的阴性预测效能为98.09%。在第4s组LN阴性且行第10组LND的患者（n = 260）与未行第10组LND的患者（n = 243）之间，手术时间、失血量、首次进食固体食物时间、住院时间和术后并发症发生率存在显著差异。两组在5年总生存率和无病生存率方面的差异无统计学意义。LN术中病理检查的敏感性、特异性和准确性分别为93.42%、96.56%和95.86%。
对于术中病理检查发现第4s组LN阴性的APGC患者，可能不建议行第10组淋巴结清扫术。
