Mengardo Valentina, Bencivenga Maria, Weindelmayer Jacopo, Pavarana Michele, Giacopuzzi Simone, de Manzoni Giovanni
General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
Department of Medical Oncology, Ospedale Civile Maggiore of Verona, Verona, Italy.
Updates Surg. 2018 Jun;70(2):207-211. doi: 10.1007/s13304-018-0549-x. Epub 2018 May 30.
Involvement of para-aortic nodes (PAN) has been detected at pathological examination in 10-25% of locally advanced gastric cancer. Based on these data of nodal diffusion, the lymphadenectomy of para-aortic stations would be desirable in locally advanced gastric cancer. However, the debate on the oncological benefit of para-aortic nodes dissection is still not solved. A review of the literature was performed and papers reporting either the rate of para-aortic nodal metastases or the long-term survival outcomes after D2+ para-aortic nodes dissection (PAND) or D3 lymphadenectomy were descriptively reported. The literature survey yielded 14 studies. Most of the papers show the outcome of series of advanced gastric cancer treated with surgery alone, while starting from 2012, 3 articles report the outcomes of D2 + PAND or D3 lymphadenectomy after preoperative chemotherapy. The rate of PAN metastases ranges between 8.5 and 28% in surgical series. Survival outcomes largely improved in series of patients treated with multimodal approach compared to those of surgery alone. In patients with clinically detected para-aortic nodal metastases, preoperative chemotherapy followed by PAND is indicated. More data are needed to clarify the indication to prophylactic PAND in the era of multimodal treatment, anyway super-extended lymphadenectomies have to be performed by experienced surgeons in dedicated centres.
在局部进展期胃癌中，病理检查发现腹主动脉旁淋巴结（PAN）受累的比例为10%-25%。基于这些淋巴结扩散的数据，对于局部进展期胃癌，行腹主动脉旁淋巴结清扫术是可取的。然而，关于腹主动脉旁淋巴结清扫术的肿瘤学获益的争论仍未解决。我们进行了文献综述，并对报告腹主动脉旁淋巴结转移率或D2+腹主动脉旁淋巴结清扫术（PAND）或D3淋巴结清扫术后长期生存结果的论文进行了描述性报道。文献检索得到14项研究。大多数论文展示了单纯手术治疗的进展期胃癌系列的结果，而从2012年开始，有3篇文章报告了术前化疗后D2+PAND或D3淋巴结清扫术的结果。在手术系列中，PAN转移率在8.5%至28%之间。与单纯手术治疗的患者系列相比，多模式治疗患者系列的生存结果有了很大改善。对于临床检测到腹主动脉旁淋巴结转移的患者，建议先行术前化疗，然后行PAND。在多模式治疗时代，需要更多数据来明确预防性PAND的适应证，无论如何，超扩大淋巴结清扫术必须由经验丰富的外科医生在专门的中心进行。
