Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Verona, Italy.
Ann Surg Oncol. 2017 Aug;24(8):2273-2280. doi: 10.1245/s10434-017-5857-8. Epub 2017 Apr 12.
The purpose of this retrospective study was to evaluate the incidence and prognostic value of metastases to "posterior" (8p, 12b/p, 13) and para-aortic lymph nodes in a large cohort of Western patients submitted to D2 plus lymphadenectomy.
Removal of "posterior" nodes was performed in 743 patients, and para-aortic lymphadenectomy in a subgroup of 390 patients. After lymph node mapping and retrieval on the fresh specimen, a median number of 41 total lymph nodes were analyzed. The median follow-up period was 37 months for the entire series and 68 months for survivors.
Of 743 included patients, 23 (3.1%) had metastases in station 8p, 12 (1.6%) in station 12b/p, and 19 (2.6%) in station 13. On the whole, 47 of 743 patients (6.3%) had positive "posterior" nodes. Para-aortic metastases were present in 42 of 390 patients (10.8%). Metastases to "posterior" stations were significantly related to depth of invasion, number of positive nodes, and surgical radicality. Distal tumors showed higher trend to metastasize to "posterior" nodes than upper third, whereas for para-aortic metastases it was the reverse. 5-year survival in patients with positivity to "posterior" nodes was 17%, with no significant difference according to 8p, 12b/p, and 13 stations; long-term outcome was overlapping to pN3b stage. 5-year survival in para-aortic positive cases was 11%, and a trend to better outcome was observed in proximal tumors.
Although metastases to "posterior" and para-aortic nodes are expression of an advanced nodal stage, not negligible survival rates are observed in subgroups of patients.
本回顾性研究的目的是评估在接受 D2 加淋巴结清扫术的大型西方患者队列中，“后”（8p、12b/p、13）和腹主动脉旁淋巴结转移的发生率和预后价值。
743 例患者行“后”淋巴结切除术，390 例患者行腹主动脉旁淋巴结切除术。在新鲜标本上进行淋巴结定位和取出后，分析了中位数为 41 个的总淋巴结。整个系列的中位随访时间为 37 个月，幸存者为 68 个月。
743 例纳入患者中，23 例（3.1%）在 8p 站有转移，12 例（1.6%）在 12b/p 站，19 例（2.6%）在 13 站。总的来说，743 例患者中有 47 例（6.3%）有“后”淋巴结阳性。390 例患者中有 42 例（10.8%）有腹主动脉旁转移。“后”站转移与浸润深度、阳性淋巴结数量和手术根治性显著相关。远端肿瘤向“后”站转移的趋势高于上三分之一，而对于腹主动脉旁转移则相反。“后”淋巴结阳性患者的 5 年生存率为 17%，根据 8p、12b/p 和 13 站无显著差异；长期结果与 pN3b 期重叠。腹主动脉旁阳性病例的 5 年生存率为 11%，近端肿瘤的预后较好。
尽管“后”和腹主动脉旁淋巴结转移是淋巴结晚期的表现，但在亚组患者中仍观察到不可忽视的生存率。
