基于初次远端胃切除的残胃癌最佳淋巴结清扫评估
Evaluation of Optimal Lymph Node Dissection in Remnant Gastric Cancer Based on Initial Distal Gastrectomy.
作者信息
Iguchi Kenta, Kunisaki Chikara, Sato Sho, Tanaka Yusaku, Miyamoto Hiroshi, Kosaka Takashi, Akiyama Hirotoshi, Endo Itaru, Rino Yasushi, Masuda Munetaka
机构信息
Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan.
出版信息
Anticancer Res. 2018 Mar;38(3):1677-1683. doi: 10.21873/anticanres.12401.
BACKGROUND/AIM: The purpose of this study was to reveal the optimal lymph node (LN) dissection in remnant gastric cancer (RGC) patients.
PATIENTS AND METHODS
We retrospectively analyzed 46 RGC patients divided into two groups: patients who underwent initial gastrectomy for benign (group B) and malignant (group M) diseases.
RESULTS
Metastasis was more frequently observed at the left (nos. 2, 4sa, 4sb, 10, and 11p/d) and right (nos. 1, 3, 4d, 7, 8a, and 12a) side LNs of RGC in groups M and B. Modified IEBLD scores (frequency of LN metastasis by median survival time of patients with metastatic LNs) were high at station nos. 10 (4.7), 11p/d (4.3/9.9), and 16 (4.3) in group M and nos. 1 (2.1), 7 (1.9) and mesojejunal (3.0) in group B.
CONCLUSION
After lymphadenectomy for initial gastric cancer, lymphatic flow toward the splenic artery was predominant. Therefore, splenectomy with para-aortic LN dissection is an option.
背景/目的：本研究旨在揭示残胃癌（RGC）患者的最佳淋巴结清扫方式。
患者与方法
我们回顾性分析了46例RGC患者，将其分为两组：因良性疾病（B组）和恶性疾病（M组）接受初次胃切除术的患者。
结果
在M组和B组的RGC患者中，左侧（第2、4sa、4sb、10和11p/d组）和右侧（第1、3、4d、7、8a和12a组）淋巴结转移更为常见。改良IEBLD评分（转移淋巴结患者的中位生存时间的淋巴结转移频率）在M组的第10组（4.7）、11p/d组（4.3/9.9）和第16组（4.3）以及B组的第1组（2.1）、第7组（1.9）和空肠系膜组（3.0）较高。
结论
初次胃癌淋巴结清扫术后，流向脾动脉的淋巴流占主导。因此，脾切除联合主动脉旁淋巴结清扫是一种选择。
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