Department of Gastric Surgery, National Cancer Centre, Tokyo, Japan.
Department of Gastric Surgery, National Cancer Centre, Tokyo, Japan.
Eur J Surg Oncol. 2021 Sep;47(9):2233-2236. doi: 10.1016/j.ejso.2021.04.019. Epub 2021 Apr 21.
Two European phase III trials comparing D1 and D2 demonstrated that D2 did not improve the overall survival and was associated with a high mortality related to splenectomy. However, a long-term follow-up study showed that the gastric cancer-related death rate was significantly higher in D1 than D2. Based on these findings, the standard surgery in Europe became D2 without pancreatico-splenectomy to prevent mortality. In contrast, the JCOG9501 phase III comparing D2 and D2 plus para-aortic nodal dissection did not showed a survival efficacy of extended lymphadenectomy, but the mortality rate was quite low in both surgeries. Subsequently, the JCOG0110 phase III study comparing D2 and spleen-preserving D2 for upper gastric cancer not invading the greater curvature clearly showed the non-inferiority of spleen preservation. Thus, spleen-preserving D2 was made the standard surgery for these tumors in Japan. However, splenectomy is often selected for complete dissection of the splenic-hilar nodes, a frequent metastatic site for upper gastric tumors invading the greater curvature. Recently, an approach involving splenic hilar nodal dissection without splenectomy has been developed.
两项比较 D1 和 D2 的欧洲 III 期临床试验表明，D2 并未改善总体生存率，并且与脾切除相关的死亡率较高有关。然而，一项长期随访研究表明，D1 的胃癌相关死亡率明显高于 D2。基于这些发现，欧洲的标准手术成为不进行胰脾切除术的 D2，以预防死亡率。相比之下，比较 D2 和 D2 加腹主动脉旁淋巴结清扫的 JCOG9501 III 期临床试验并未显示扩大淋巴结清扫术的生存疗效，但两种手术的死亡率都相当低。随后，比较不侵犯大弯侧的上部胃癌的 D2 和保留脾脏的 D2 的 JCOG0110 III 期研究清楚地表明了保留脾脏的非劣效性。因此，在日本，保留脾脏的 D2 成为这些肿瘤的标准手术。然而，对于完全清扫脾门淋巴结的手术，脾切除术通常用于侵犯大弯侧的上部胃肿瘤，因为这些淋巴结是常见的转移部位。最近，一种涉及不进行脾切除术的脾门淋巴结清扫术的方法已经得到发展。
