Li Jing-Quan, He Donglei, Liang Yue-Xiang
Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, P.R. China.
Oncol Lett. 2021 Jun;21(6):467. doi: 10.3892/ol.2021.12728. Epub 2021 Apr 12.
The extent of lymph node (LN) dissection has been a topic of interest in gastric cancer (GC) surgery. D2 lymphadenectomy is considered the standard surgical procedure for most resectable advanced GC cases. The value and indications of more extended lymphadenectomy than D2 remain unclear. Currently, the controversial stations beyond the D2 range are mainly focused on no. 14v, no. 16a2/b1 and no. 13 LN stations. The metastatic rate of no. 14v LN is relatively high in advanced distal GC, particularly in patients with suspicious no. 6 LN metastasis. D2 plus no. 14v LN dissection may be attributed to improved survival outcomes for patients with obvious no. 6 LN metastasis. Although GC with para-aortic lymph node (PALN) metastases is considered an M1 disease beyond surgical cure, patients with limited PALN metastases may benefit from the treatment strategy of adjuvant chemotherapy followed by D2 plus no. 16a2-b1 LN dissection. In addition, D2 plus no. 13 LN dissection may be an option in a potentially curative gastrectomy for GC with duodenal invasion. The present review discusses the current status and future perspectives of D2 plus lymphadenectomy.
淋巴结清扫范围一直是胃癌手术中备受关注的话题。D2淋巴结清扫术被认为是大多数可切除进展期胃癌病例的标准手术方式。超过D2范围的更广泛淋巴结清扫的价值和适应证仍不明确。目前,超出D2范围存在争议的淋巴结站主要集中在第14v组、第16a2/b1组和第13组淋巴结站。在进展期远端胃癌中,第14v组淋巴结转移率相对较高,尤其是在第6组淋巴结可疑转移的患者中。对于第6组淋巴结明显转移的患者,D2加第14v组淋巴结清扫可能有助于改善生存结局。尽管伴有主动脉旁淋巴结转移的胃癌被认为是无法手术治愈的M1期疾病,但主动脉旁淋巴结转移局限的患者可能从辅助化疗后行D2加第16a2 - b1组淋巴结清扫的治疗策略中获益。此外,对于十二指肠受侵的胃癌行根治性胃切除术时,D2加第13组淋巴结清扫可能是一种选择。本综述讨论了D2加淋巴结清扫的现状和未来展望。
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