Li G H, Li Z T, Jia S X, Li Y S
Zhonghua Zhong Liu Za Zhi. 1986 Sep;8(5):377-80.
Study on the lymphatic metastasis rule of 83 cases of gastric antrum carcinoma showed overall lymphatic metastasis rate (LMR) was 80.7% (67/83) and overall metastasis degree was 22.9% (i. e. 440 positive in the 1926 lymph nodes). There is no significant difference (P greater than 0.05) in LMR in the second line (N2) for the lesions with various biological features. Growth mode and histological type have the greatest influence on LMR in the third line (N3). N3 in the infiltration type and poorly or undifferentiated type is obviously higher than that in the localized and well-differentiated types (P less than 0.01). In view of the results, we conclude that extended radical operation (R3) should not be used as a routine operation for gastric cancer and be selectively carried out referring to the biological features of the tumor. In general, stage I gastric cancer is not indicated for R3; stages II and III are absolute indications; stage IV is the relative indication, i. e. group T1-4a N3M0 can be indicated; a part of T4b can also be treated by R3 resecting en bloc the involved organs but group M1 would miss the radical treatment. Besides, total gastrectomy or combined resection of spleen, body and tail of the pancreas should not be done routinely for gastric antrum cancer. They are to be performed according to the degree of involvement of the gastric body and metastasis in the lymph node groups 1, 2 and 3, 4.
83例胃窦癌淋巴转移规律的研究显示，总体淋巴转移率（LMR）为80.7%（67/83），总体转移程度为22.9%（即1926个淋巴结中有440个阳性）。不同生物学特征病变的二线（N2）LMR无显著差异（P＞0.05）。生长方式和组织学类型对三线（N3）LMR影响最大。浸润型及低分化或未分化型的N3明显高于局限型及高分化型（P＜0.01）。鉴于上述结果，我们得出结论，扩大根治术（R3）不应作为胃癌的常规手术方式，而应参照肿瘤生物学特征选择性实施。一般而言，Ⅰ期胃癌不适合行R3；Ⅱ期和Ⅲ期是绝对适应证；Ⅳ期是相对适应证，即T1 - 4a N3M0组可考虑；部分T4b也可通过R3整块切除受累器官进行治疗，但M1组则错过根治性治疗时机。此外，胃窦癌不应常规行全胃切除术或联合脾脏、胰体尾切除术。应根据胃体受累程度及第1、2组和第3、4组淋巴结转移情况来决定是否实施。
