Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
World J Surg Oncol. 2019 Feb 6;17(1):28. doi: 10.1186/s12957-019-1572-1.
The optimal extent of lymph node (LN) dissection for advanced distal gastric cancer remains controversial. The present study compared the safety and efficacy of extended LN dissection (D2 plus) with standard D2 radical surgery for advanced distal gastric cancer.
Eligible patients were enrolled and randomly assigned into two groups: D2 group and D2 plus group. Patients in the D2 group received standard D2 LN dissection, while patients in the D2 plus group received an additional nos. 8p, 12b, 13, and 14v LNs dissection. The clinicopathological and surgical data of these two groups were compared, and the factors that may influence survival were analyzed.
Seventy patients were enrolled, out of which 64 patients were analyzed. There were no significant differences in the operative time, blood loss, and complications between the two groups. In the D2 plus group, the positive rate of the nos. 12b, 13, and 14v LN was 3.1%, 9.4%, and 12.5%, respectively. The positive rate of the no. 13 LN correlated with the duodenal involvement, while the positive rate of the no. 14v LN correlated with no. 6 LN metastasis. The survival analysis indicated that among patients with duodenum involvement, the 3-year disease-free survival rate of the D2 plus group was significantly better than that of the D2 group.
Duodenum involvement and positive no. 6 LN were high-risk factors of advanced distal gastric cancer. D2 plus radical surgery turned out to be safe and feasible, and may improve the prognosis of these patients. However, further clinical trials are still warranted.
This study is registered with ClinicalTrials.gov as NCT01836991 , registered on 22 April 2013.
对于进展期远端胃癌，淋巴结清扫的最佳范围仍存在争议。本研究比较了扩大淋巴结清扫术（D2 加）与标准 D2 根治术治疗进展期远端胃癌的安全性和疗效。
纳入符合条件的患者并随机分为两组：D2 组和 D2 加组。D2 组患者接受标准 D2 淋巴结清扫术，而 D2 加组患者接受额外的第 8p、12b、13 和 14v 淋巴结清扫术。比较两组的临床病理和手术数据，并分析可能影响生存的因素。
共纳入 70 例患者，其中 64 例患者进行了分析。两组患者的手术时间、出血量和并发症无显著差异。D2 加组第 12b、13 和 14v 淋巴结的阳性率分别为 3.1%、9.4%和 12.5%。第 13 淋巴结的阳性率与十二指肠受累有关，而第 14v 淋巴结的阳性率与第 6 淋巴结转移有关。生存分析表明，在有十二指肠受累的患者中，D2 加组的 3 年无病生存率明显优于 D2 组。
十二指肠受累和阳性第 6 淋巴结是进展期远端胃癌的高危因素。D2 加根治术安全可行，可能改善这些患者的预后。但仍需要进一步的临床试验。
本研究在 ClinicalTrials.gov 上注册为 NCT01836991，于 2013 年 4 月 22 日注册。
