Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Gastric Cancer. 2018 Mar;21(2):296-302. doi: 10.1007/s10120-017-0733-6. Epub 2017 Jun 5.
The optimal extent of lymph node (LN) dissection for gastric cancer with duodenal invasion is yet to be clarified. This study sought to evaluate the significance of gastrectomy with D2-plus lymphadenectomy including posterior LNs along the common hepatic artery (no. 8p), hepatoduodenal ligament LNs along the bile duct (no. 12b) and those behind the portal vein (no. 12p), LNs on the posterior surface of the pancreatic head (no. 13), LNs along the superior mesenteric vein (no. 14v) and para-aortic LNs around the left renal vein (nos. 16a2 and 16b1) dissection.
Patients with gastric cancer with duodenal invasion undergoing R0 gastrectomy from January 2000 to December 2015 were enrolled. The therapeutic value index (TVI) of each LN dissection was calculated by multiplying the incidence of metastasis to each LN station by the 5-year overall survival (OS) rate of the patients with metastasis to the station.
In total, 117 patients were eligible. The 5-year OS rates (and TVI) of the patients with metastasis to LNs were 40.4% (7.4) in no. 12b, 25.4% (6.8) in no. 13, 32.0% (6.1) in no. 14v, 50.0% (13.0) in no. 16a2 and 40.0% (10.0) in no. 16b1. None of the patients with metastasis in no. 8p or no. 12p survived 5 years or longer.
In a potentially curative gastrectomy for gastric cancer with duodenal invasion, there may be some survival benefit in dissection of nos. 12b, 13, 14v, 16a2 and 16b1 LNs, while no benefit was seen in dissection of nos. 8p or 12p LNs.
对于侵犯十二指肠的胃癌，淋巴结清扫的最佳范围仍不明确。本研究旨在评估包括沿肝总动脉后方（第 8p 站）、胆管旁肝十二指肠韧带（第 12b 站）和门静脉后方（第 12p 站）、胰头后（第 13 站）、沿肠系膜上静脉（第 14v 站）和腹主动脉旁左肾静脉周围（第 16a2 和 16b1 站）淋巴结清扫的 D2+淋巴结清扫术治疗胃切除术的意义。
纳入 2000 年 1 月至 2015 年 12 月接受 R0 胃切除术的侵犯十二指肠的胃癌患者。通过将每个淋巴结站转移的发生率乘以该站转移患者的 5 年总生存率（OS）计算每种淋巴结清扫术的治疗价值指数（TVI）。
共有 117 例患者符合条件。发生淋巴结转移的患者 5 年 OS 率（和 TVI）分别为第 12b 站 40.4%（7.4）、第 13 站 25.4%（6.8）、第 14v 站 32.0%（6.1）、第 16a2 站 50.0%（13.0）和第 16b1 站 40.0%（10.0）。无 1 例第 8p 或第 12p 站淋巴结转移的患者存活 5 年或以上。
在有治愈可能的侵犯十二指肠的胃癌胃切除术，清扫第 12b、13、14v、16a2 和 16b1 站淋巴结可能有生存获益，而清扫第 8p 或 12p 站淋巴结没有获益。
