Goshen Center for Cancer Care, Goshen, IN, 46526, USA.
Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA.
J Gastrointest Surg. 2019 Feb;23(2):393-401. doi: 10.1007/s11605-018-4056-7. Epub 2019 Jan 2.
Extended lymph node dissection (ELND) remains an important component of curative intent resection of mid-stage gastric cancer (GC). Benefits include enhanced staging accuracy, extending regional disease control, and optimizing potential curability. ELND during gastrectomy remains underutilized in US centers due to a low prevalence of GC operations.
The traditional en bloc ELND was modified into a two-step technique to facilitate greater ease of dissection with better exposure. After completion of the gastrectomy component, retrogastric nodes are dissected in a separate, contiguous specimen. Resulting data were compared to outcomes after en bloc resection.
Of 179 consecutive patients undergoing gastrectomy, 129 underwent an ELND (73%). There were 97 men and 32 women, with a median age of 64 years (range 24-98). The median total LN count was 25 (3-86). The two-step dissection yielded an average of 18.3 (± 8.5 S.D.) perigastric and 12.1 (± 5.8) retrogastric nodes. Two-step LND was associated with lower estimated blood loss (265 vs. 448 ml, p = 0.0005), lower transfusion requirements (6 vs. 28%, p = 0.007), greater mean total LN counts (30 vs. 26, p = 0.03), and a greater rate of obtaining at least 15 or 20 LNs (91 vs. 77% and 83 vs. 65%, p = 0.05). Major morbidity (overall 16%), length of stay, and survival outcomes were not different.
The two-step LND technique as described was found to be associated with favorable operative and postoperative outcome parameters and an excellent LN yield. It can be recommended for standard ELND indications in the absence of macroscopically abnormal LNs.
扩大淋巴结清扫术（ELND）仍然是中晚期胃癌（GC）根治性切除的重要组成部分。其益处包括提高分期准确性、扩大区域性疾病控制范围和优化潜在的可治愈性。由于美国 GC 手术的发生率较低，ELND 在美中中心的应用仍然不足。
传统的整块 ELND 被修改为两步技术，以方便更轻松地进行解剖，并获得更好的暴露效果。在完成胃切除术部分后，在单独的连续标本中解剖胃后淋巴结。将所得数据与整块切除后的结果进行比较。
在 179 例连续接受胃切除术的患者中，有 129 例（73%）接受了 ELND。其中 97 例为男性，32 例为女性，中位年龄为 64 岁（范围 24-98 岁）。中位总淋巴结计数为 25（3-86）枚。两步解剖平均获得胃旁和胃后淋巴结分别为 18.3（±8.5 S.D.）枚和 12.1（±5.8）枚。两步 LND 与较低的估计失血量（265 与 448 ml，p=0.0005）、较低的输血需求（6 与 28%，p=0.007）、更多的平均总淋巴结计数（30 与 26，p=0.03）以及更高的获得至少 15 或 20 枚淋巴结的比例（91 与 77%和 83 与 65%，p=0.05）相关。主要发病率（总体为 16%）、住院时间和生存结果无差异。
所描述的两步 LND 技术与有利的手术和术后结果参数以及出色的淋巴结收获相关。在没有明显异常淋巴结的情况下，可以推荐用于标准的 ELND 适应证。
