Ye Zaisheng, Zeng Yi, Wei Shenghong, Wang Yi, Lin Zhenmeng, Lin Zhitao, Chen Xiaoling, Chen Luchuan
Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital and Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China.
Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital and Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China. Email:
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Oct 25;21(10):1129-1135.
To analyze the feasibility of No.8p lymphadenectomy for the patients with advanced gastric cancer and to preliminaryly explore its value in improving prognosis.
Clinical data of 1158 patients with advanced gastric cancer undergoing radical gastrectomy plus D2 or above D2 lymphadenectomy (No.8 lymphadenectomy) from July 2003 to July 2013 at Department of Gastrointestinal Surgery, Fujian Cancer Hospital were collected. A retrospective cohort study was carried out. Among 1158 patients, 343 patients from July 2003 to June 2008 only received No.8a lymph node dissection (No.8a group), and 815 patients from July 2008 to July 2013 received No.8a+No.8p lymph node dissection (No.8a+No.8p group). Patients in No.8a group received the dissection of the lymph nodes in the upper margin of the pancreas and the front of total hepatic artery, and those in No.8a+No.8p group, on the basis of No.8a group, received the dissection of lymph nodes in the common hepatic artery and the left lymph nodes behind the hepatic artery and the portal vein. The metastasis degree and metastasis rate of lymph node(No.8a and No.8p), as well as intraoperative and postoperative presentations in both groups were investigated. The prognosis of two groups were analyzed with Kaplan-Meier method and Log-rank test.
Among 1158 patients with advanced gastric cancer, 849 were males and 309 were females with aged 17 to 83(58.5 ±11.7) years. Radical distal gastrectomy was performed in 325 cases (28.1%) and radical total gastrectomy in 833 cases(71.9%). All the patients completed operations successfully. A total of 2587 No.8a lymph nodes were removed, and the lymph node metastasis rate and metastasis degree of No.8a were 20.6% (239/1158) and 13.0%(336/2587), respectively. A total of 2170 No.8p lymph nodes were removed, and the lymph node metastasis rate and metastasis degree of No.8p were 10.9%(89/815) and 7.2%(156/2170), respectively. The operation time of the No.8a+No.8p group was longer than that of No.8a group [(180.2±40.3) minutes vs. (168.4±41.8) minutes], and the difference was statistically significant (t=-4.627, P=0.000). However, intraoperative blood loss [(222.8±92.8) ml vs. (215.6±91.1) ml], postoperative 1-day peritoneal drainage volume [(257.7±120.0) ml vs. (270.3±121.0) ml], time to withdraw of gastric tube [(2.1±0.9) days vs. (2.2±0.8) days], time to withdraw of peritoneal tube [(6.8±1.1) days vs. (6.9±1.1) days], time to withdraw of nasal feeding tube[(6.5±1.2) days vs. (6.4±1.1) days], the morbidity of complications [19.8%(68/343) vs. 16.0%(130/815)] and postoperative hospital stay [(8.1±3.0) days vs.(8.3±3.1) days] in No.8a group and No.8a+No.8p group were not significantly different(all P>0.05). The average follow-up period was 41(2 to 144) months. The median postoperative survival was 83.0 months, and the 1-, 2-, and 5-year survival rates were 90.9%, 78.8% and 56.9% in No.8a group respectively. The median survival was 94.8 months, 1-, 2-, and 5-survival rates were 94.9%, 82.3% and 63.0% in No.8a+No.8p group respectively. The survival rate of No.8a+No.8p group was significantly higher than that of No.8a group (P=0.016). The stratified analysis showed that in stage II patients, the survival rate of No.8a+No.8p lymph node dissection was significantly higher than that of only No.8a lymph node dissection(P=0.021), but difference of survival between two groups was not significantly different in stage I patients(P=0.469) and stage III patients (P=0.820).
For the patients with advanced gastric cancer, the dissection of No.8a+No.8p is safe and feasible, and may improve the prognosis, especially for those with stage II, suggesting that No.8a+No.8p lymphadenectomy should be performed for selected patients with advanced gastric cancer.
分析进展期胃癌患者行8p淋巴结清扫术的可行性，并初步探讨其对改善预后的价值。
收集2003年7月至2013年7月在福建省肿瘤医院胃肠外科行根治性胃癌切除术加D2或D2以上淋巴结清扫术（8组淋巴结清扫术）的1158例进展期胃癌患者的临床资料。进行回顾性队列研究。1158例患者中，2003年7月至2008年6月的343例患者仅行8a淋巴结清扫（8a组），2008年7月至2013年7月的815例患者行8a + 8p淋巴结清扫（8a + 8p组）。8a组患者清扫胰腺上缘及肝总动脉前方的淋巴结，8a + 8p组患者在8a组基础上清扫肝总动脉及肝动脉和门静脉后方左侧的淋巴结。观察两组患者8a和8p淋巴结转移程度及转移率，以及术中及术后情况。采用Kaplan-Meier法和Log-rank检验分析两组患者的预后。
1158例进展期胃癌患者中，男性849例，女性309例，年龄17～83岁（58.5±11.7）岁。行根治性远端胃癌切除术325例（28.1%），根治性全胃切除术833例（71.9%）。所有患者均成功完成手术。共清扫8a淋巴结2587枚，8a淋巴结转移率和转移程度分别为20.6%（239/1158）和13.0%（336/2587）。共清扫8p淋巴结2170枚，8p淋巴结转移率和转移程度分别为10.9%（89/815）和7.2%（156/2170）。8a + 8p组手术时间长于8a组[（180.2±40.3）分钟对（168.4±41.8）分钟]，差异有统计学意义（t = -4.627，P = 0.000）。但8a组与8a + 8p组术中出血量[（222.8±92.8）ml对（215.6±91.1）ml]、术后第1天腹腔引流量[（257.7±120.0）ml对（270.3±121.0）ml]、拔胃管时间[（2.1±0.9）天对（2.2±0.8）天]、拔腹腔引流管时间[（6.8±1.1）天对（6.9±1.1）天]、拔鼻饲管时间[（6.5±1.2）天对（6.4±1.1）天]、并发症发生率[19.8%（68/343）对16.0%（130/81）]及术后住院时间[（8.1±3.0）天对（8.3±3.1）天]比较，差异均无统计学意义（均P>0.05）。平均随访时间41（2～144）个月。8a组术后中位生存时间为83.0个月，1年、2年和5年生存率分别为90.9%、78.8%和56.9%。8a + 8p组中位生存时间为94.8个月，1年、2年和5年生存率分别为94.9%、82.3%和63.0%。8a + 8p组生存率明显高于8a组（P = 0.016）。分层分析显示，Ⅱ期患者中，8a + 8p淋巴结清扫术患者生存率明显高于仅行8a淋巴结清扫术患者（P = 0.021），但Ⅰ期患者（P = 0.469）和Ⅲ期患者两组生存率差异无统计学意义（P = 0.820）。
对于进展期胃癌患者，行加8p淋巴结清扫术安全可行，可能改善预后，尤其对Ⅱ期患者，提示对部分进展期胃癌患者应行8a + 8p淋巴结清扫术。
