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进展期胃癌扩大“D2+”淋巴结清扫术的现状

Current status of extended 'D2 plus' lymphadenectomy in advanced gastric cancer.

作者信息

Li Jing-Quan, He Donglei, Liang Yue-Xiang

机构信息

Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, P.R. China.

出版信息

Oncol Lett. 2021 Jun;21(6):467. doi: 10.3892/ol.2021.12728. Epub 2021 Apr 12.


DOI:10.3892/ol.2021.12728
PMID:33907577
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8063322/
Abstract

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.

摘要

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。

相似文献

[1]
Current status of extended 'D2 plus' lymphadenectomy in advanced gastric cancer.

Oncol Lett. 2021-6

[2]
Current status of lymph node dissection in gastric cancer.

Chin J Cancer Res. 2021-4-30

[3]
Prognostic significance of 14v-lymph node dissection to D2 dissection for lower-third gastric cancer.

World J Clin Cases. 2019-9-26

[4]
Prognostic impact of D2-plus lymphadenectomy and optimal extent of lymphadenectomy in advanced gastric antral carcinoma: Propensity score matching analysis.

Chin J Cancer Res. 2020-2

[5]
[Extent of lymphadenectomy for local advanced gastric cancer in the era of perioperative treatment and minimally invasive surgery].

Zhonghua Wei Chang Wai Ke Za Zhi. 2022-4-25

[6]
[Clinical value of superior mesenteric vein (No.14v) lymph node dissection in D2 gastrectomy for locally advanced distal gastric cancer].

Zhonghua Wei Chang Wai Ke Za Zhi. 2018-10-25

[7]
Comparison of D2 and D2 plus radical surgery for advanced distal gastric cancer: a randomized controlled study.

World J Surg Oncol. 2019-2-6

[8]
Is it worthy of adding dissection of the superior mesenteric vein lymph node (14v) to standard D2 gastrectomy for distal gastric cancers with No. 6 lymph node metastasis?

Clin Transl Oncol. 2019-4-11

[9]
Survival benefit of "D2-plus" gastrectomy in gastric cancer patients with duodenal invasion.

Gastric Cancer. 2017-6-5

[10]
[Three Cases of No. 16 Lymph Node Metastasis-Positive Gastric Cancer Successfully Treated with Chemotherapy and Para-Aortic Lymph Node Dissection].

Gan To Kagaku Ryoho. 2021-12

引用本文的文献

[1]
The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2).

Medicina (Kaunas). 2025-7-16

[2]
Current clinical trials on gastric cancer surgery in China.

World J Gastrointest Oncol. 2024-11-15

[3]
Minimally Invasive and Open Gastrectomy for Gastric Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials.

Ann Surg Oncol. 2023-9

本文引用的文献

[1]
Cancer burden and trends in China: A review and comparison with Japan and South Korea.

Chin J Cancer Res. 2020-4

[2]
Prognostic Factors for Para-aortic Lymph Node Dissection After Neoadjuvant Chemotherapy for Gastric Cancer.

Anticancer Res. 2020-4

[3]
Factors associated with metastasis in superior mesenteric vein lymph node in subtotal gastrectomy for gastric cancer: Retrospective case control study.

Chin J Cancer Res. 2020-2

[4]
"D2 plus" lymphadenectomy is associated with improved survival in distal gastric cancer with clinical serosa invasion: a propensity score analysis.

Sci Rep. 2019-12-16

[5]
Prognostic significance of 14v-lymph node dissection to D2 dissection for lower-third gastric cancer.

World J Clin Cases. 2019-9-26

[6]
Role of D2 gastrectomy in gastric cancer with clinical para-aortic lymph node metastasis.

World J Gastroenterol. 2019-5-21

[7]
Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with metastatic gastric cancer: a JSMO-ESMO initiative endorsed by CSCO, KSMO, MOS, SSO and TOS.

Ann Oncol. 2019-1-1

[8]
Phase II trial of neoadjuvant chemotherapy with intraperitoneal paclitaxel, S-1, and intravenous cisplatin and paclitaxel for stage IIIA or IIIB gastric cancer.

J Surg Oncol. 2019-1

[9]
Therapeutic Value of Lymph Node Dissection Along the Superior Mesenteric Vein and the Posterior Surface of the Pancreatic Head in Gastric Cancer Located in the Lower Third of the Stomach.

Yonago Acta Med. 2018-9-26

[10]
Risk factors for metastasis to No.14v lymph node and prognostic value of 14v status for gastric cancer patients after surgery.

Jpn J Clin Oncol. 2018-4-1

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