Cao Yinghao, Xiong Lijuan, Deng Shenghe, Shen Liming, Li Jiang, Wu Ke, Wang Jiliang, Tao KaiXiong, Wang Guobin, Cai Kailin
Department of Gastrointestinal Surgery Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2018 Jul;97(27):e11411. doi: 10.1097/MD.0000000000011411.
To analyze the impact of perigastric lipolymphatic tissue grouping by the surgeon on the number of pathologic sampled lymph nodes and to explore the appropriate lymph node delivery process.The authors collected the medical records of gastric cancer patients who were hospitalized in Wuhan Union Hospital during the period January 2016 to January 2018. The authors selected 126 patients and divided them into experimental group and control group, 63 cases in each group. Samples of standard complete gastrectomy or distal gastrectomy +D2 lymph node dissection was performed. In experimental group, the fresh en bloc specimen was treated by the surgeon before the formalin fixation. The perigastric lipolymphatic tissue was divided into the lymph node grouping according to JSGC guideline III. Then the stomach and each group of lipolymphatic tissue were fixed and then transferred to the pathologic department, then the lymph nodes were harvested by the pathological technician. In control group, the whole en bloc specimen was fixed with formalin and then lymph nodes were detected by palpation and thin slice inspection, and then harvested by the pathological technician. The lymph node acquisition was compared in 2 groups.The total number of lymph nodes in experimental group is 2611, the number of negative lymph nodes is 2273; the total number of lymph nodes in control group is 1643, the number of negative lymph nodes is 1351; the comparison difference in 2 groups was statistical sense (P < .01); patients with lymph node which reach 25 pieces/person of experimental group could reach a ratio of 90.1%, and that is 47.6% in the control group, the comparison difference in 2 groups was statistical sense (P < .01), the number of positive lymph nodes did not increase significantly compared with the control group, and there was no statistical significance in the 2 groups.Dissecting the perigastric lipolymphatic tissue into lymph node groups by the surgeon might improve the total number of lymph node harvested by the pathological technician, and increase the rate of cases with >25 lymph nodes. Our results also implicated that, when the routing harvested lymph nodes were more than 20, the increasing number by perigastric lipolymphatic tissue grouping might result from more negative lymph nodes detected and might not result in stage migrating.
分析外科医生对胃周脂肪淋巴组织分组对病理采样淋巴结数量的影响，并探索合适的淋巴结送检流程。作者收集了2016年1月至2018年1月期间在武汉协和医院住院的胃癌患者的病历。作者选取126例患者，分为实验组和对照组，每组63例。进行标准全胃切除术或远端胃切除术+D2淋巴结清扫术。在实验组中，新鲜整块标本在福尔马林固定前由外科医生处理。胃周脂肪淋巴组织根据日本胃癌治疗指南III进行淋巴结分组。然后将胃和每组脂肪淋巴组织固定，再送至病理科，然后由病理技术员采集淋巴结。在对照组中，整块标本用福尔马林固定，然后通过触诊和薄片检查检测淋巴结，然后由病理技术员采集。比较两组的淋巴结获取情况。实验组淋巴结总数为2611个，阴性淋巴结数为2273个；对照组淋巴结总数为1643个，阴性淋巴结数为1351个；两组比较差异有统计学意义（P<0.01）；实验组淋巴结达到25枚/人的患者比例可达90.1%，对照组为47.6%，两组比较差异有统计学意义（P<0.01），阳性淋巴结数量与对照组相比无明显增加，两组间无统计学意义。外科医生将胃周脂肪淋巴组织解剖成淋巴结组可能会提高病理技术员采集的淋巴结总数，并增加淋巴结>25枚的病例比例。我们的结果还表明，当常规采集淋巴结超过20枚时，胃周脂肪淋巴组织分组增加的数量可能是由于检测到更多的阴性淋巴结，而可能不会导致分期迁移。
