Lino-Silva Leonardo S, Mendoza-Lara Hortencia E, León-Takahashi Alberto M, Zepeda-Najar César, Salcedo-Hernández Rosa A
Department of Surgical Pathology, Instituto Nacional de Cancerología, Tlalpan, Mexico City, Mexico.
Department of Surgical Oncology, Instituto Nacional de Cancerología, Tlalpan, Mexico City, Mexico.
Prz Gastroenterol. 2021;16(3):224-228. doi: 10.5114/pg.2021.108987. Epub 2021 Sep 17.
Lymph node (LN) dissection is an important prognostic factor in gastric cancer. There is little information comparing the LN count depending on whether they are dissected in the operating room or in the pathology laboratory.
To establish if the LN count is greater in either of them.
From 2015 to 2017 all consecutive gastrectomies with D2 dissection were prospectively evaluated based in either of 2 protocols: One started in the operating room where the surgeon separated the LN levels and then submitted the entire adipose tissue with LNs (undissected) to pathology in separate containers; the pathologist dissected the LNs from the specimens. The second protocol consisted of sending the tissue/LNs to pathology as usual (adipose tissue and LN attached to the stomach).
A total of 83 patients were analysed. The mean age was 58.4 years. The median number of LNs dissected in the protocol starting in the operating room was 56 (IQR: 37-74), whereas the pathology laboratory dissected a median of 39 LNs (IQR 26-53) ( = 0.005). The survival of cases dissected by both protocols were comparable (median survival of 48 and 43 months, = 0.316).
The LN final count is significantly higher when LN levels are separated beforehand in the operating room compared to dissection only in pathology; however, this does not impact survival, perhaps because the number of dissected nodes in both groups is high and the quality of the surgery is good.
淋巴结清扫是胃癌的一个重要预后因素。关于根据淋巴结是在手术室还是病理实验室进行清扫的淋巴结计数比较，相关信息较少。
确定两者中哪一种的淋巴结计数更高。
从2015年至2017年，对所有连续进行D2清扫的胃切除术患者按照两种方案之一进行前瞻性评估：一种方案是在手术室开始，外科医生分离淋巴结水平，然后将带有淋巴结的整个脂肪组织（未清扫）分别装入容器送至病理科；病理学家从标本中清扫淋巴结。第二种方案是像往常一样将组织/淋巴结送至病理科（附着于胃的脂肪组织和淋巴结）。
共分析了83例患者。平均年龄为58.4岁。在手术室开始的方案中清扫的淋巴结中位数为56个（四分位间距：37 - 74），而病理实验室清扫的淋巴结中位数为39个（四分位间距26 - 53）（P = 0.005）。两种方案清扫的病例的生存率相当（中位生存期分别为48个月和43个月，P = 0.316）。
与仅在病理科进行清扫相比，在手术室预先分离淋巴结水平时，最终的淋巴结计数显著更高；然而，这并不影响生存率，可能是因为两组清扫的淋巴结数量都很多且手术质量良好。
