Vu Tuan Anh Nguyen, Dang Quang Thong, Lam Vuong Nguyen, Nguyen Viet Hai, Ho Le Minh Quoc, Tran Quang Dat, Dang Truong Thai, Tran Anh Minh, Doan Thuy Nguyen, Nguyen Hoang Bac, Nguyen Trung Tin, Duy Vo Long
General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM.
Gastrointestinal Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, VNM.
Cureus. 2023 Jun 30;15(6):e41236. doi: 10.7759/cureus.41236. eCollection 2023 Jun.
Introduction Lymph node (LN) metastasis happens even in early gastric cancer (GC) even in LN stations that are not adjacent to the primary tumor. Total or subtotal gastrectomy (TG or sTG) can be performed in the middle third of the GC if the negative proximal margin is maintained. These procedures differed in the extent of LN dissection; therefore, oncology considerations must be taken into consideration when selecting the appropriate procedure. Methods This was a cross-sectional study involving 98 patients suffering from middle-third GC. The metastatic lymph nodes (mLN) ratio was calculated in each case by the ratio between the number of mLN and the number of total LNs retrieved. We compare the difference in the total LN retrieved, number of mLN, and rate of positive LN (N+) between the two groups TG and sTG. Results The majority of patients had advanced GC (82.7% pT2-4). About 65.3% of patients had metastasis LN. The events of LN metastasis and skipped LN metastasis happened even in tumors contained in the submucosal layer. The metastasis rates in each LN station were also increasing in correlation with the depth of tumor invasion. For LN station No. 2, 4sa, 10, 11d (which are not mandatory) in sTG, the rate of mLN was 0% for the pT1-3 tumor, regardless of tumor longitudinal location. The rate of mLN for each station was higher in adjacent stations of the tumor (No. 1-3-5-7 in lesser curvature, No. 4sb-4d-6 in greater curvature, No.1-3-4sb in the anterior wall, No. 3-7-12a in the posterior wall). The total LN retrieved, number of mLN, and rate of positive LN were statistically higher in the TG group compared to the sTG group. However, the mean mLN ratios between the two groups were comparable (p = 0.116). Conclusion In accordance with the macroscopic and microscopic characteristics, we observed a stratified distribution of mLN in the middle third of the GC. With these early results, sTG combined with standard lymphadenectomy was an acceptable treatment for T1-T3 middle-third GC in terms of mLN distribution. Total No. 4sb LN dissection might also be reserved in gastrectomy for T1-T3 GC.
引言
即使在早期胃癌（GC）中，也会发生淋巴结（LN）转移，甚至在与原发肿瘤不相邻的LN站也会出现转移。如果近端切缘阴性，可对胃中部三分之一的GC进行全胃或次全胃切除术（TG或sTG）。这些手术在LN清扫范围上有所不同；因此，在选择合适的手术时必须考虑肿瘤学因素。
方法
这是一项横断面研究，涉及98例胃中部三分之一GC患者。通过转移淋巴结（mLN）数量与回收的总LN数量之比计算每种情况下的mLN比率。我们比较了TG组和sTG组在回收的总LN数量、mLN数量和阳性LN（N+）率方面的差异。
结果
大多数患者患有进展期GC（82.7%，pT2-4）。约65.3%的患者发生LN转移。即使在黏膜下层的肿瘤中也会发生LN转移和跳跃式LN转移。每个LN站的转移率也随着肿瘤浸润深度的增加而升高。对于sTG中不强制清扫的第2、4sa、10、11d号LN站，pT1-3肿瘤的mLN率为0%，与肿瘤纵向位置无关。肿瘤相邻站（小弯侧的第1-3-5-7号、大弯侧的第4sb-4d-6号、前壁的第1-3-4sb号、后壁的第3-7-12a号）每个站的mLN率更高。与sTG组相比，TG组回收的总LN数量、mLN数量和阳性LN率在统计学上更高。然而，两组之间的平均mLN比率具有可比性（p = 0.116）。
结论
根据宏观和微观特征，我们观察到GC胃中部三分之一的mLN呈分层分布。基于这些早期结果，就mLN分布而言，sTG联合标准淋巴结清扫术是T1-T3胃中部三分之一GC的一种可接受的治疗方法。在T1-T3 GC的胃切除术中，也可能保留第4sb号LN的全部清扫。
