Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland.
World J Surg Oncol. 2023 Aug 26;21(1):265. doi: 10.1186/s12957-023-03146-y.
In gastric cancer (GC), the pN-stage is an important prognostic factor influencing treatment. Along with the depth of invasion of the tumor, the presence of nodal metastases is one of the most important prognostic factors guiding treatment strategies in gastric cancer. Examining a small number of lymph nodes may lead to understaging of the disease; hence, it is essential for the nodal status to be precisely assessed. In this study, we explored whether dissecting lymph node stations into separate samples by the surgeon from the gastric cancer surgical specimen affects the quality of nodal status evaluation and patient outcome.
The clinical data of 130 GC patients treated at the Helsinki University Hospital between 2016 and 2019 was reviewed. The performed operations included 59 total and 71 subtotal gastrectomies. The processing of the surgical specimen before the pathological examination was assessed from the operation records and pathology reports. The association of the number of examined lymph nodes with other variables was assessed, and multivariate survival analysis was performed to explore the independent prognostic factors in disease-specific survival.
Dissecting lymph node stations into separate specimens before pathological evaluation yielded a significantly greater number of examined lymph nodes compared with a specimen without intervention (median 34.5 vs 21.0, p < 0.001). The pT-stage, the pN-stage, and the extent of lymphadenectomy were identified as independent prognostic factors, whereas dissecting the specimen's lymph node stations did not associate with survival.
Dissecting lymph node stations into separate specimens results in a greater number of examined lymph nodes, which has the potential to lead to a more reliable pN-stage assessment.
在胃癌（GC）中，pN 分期是影响治疗的重要预后因素。随着肿瘤浸润深度的增加，淋巴结转移的存在是指导胃癌治疗策略的最重要预后因素之一。检查少量的淋巴结可能导致疾病分期不足；因此，准确评估淋巴结状态至关重要。在这项研究中，我们探讨了外科医生是否将胃癌手术标本中的淋巴结站分开进行解剖，是否会影响淋巴结状态评估的质量和患者的预后。
回顾了 2016 年至 2019 年在赫尔辛基大学医院治疗的 130 例 GC 患者的临床数据。所进行的手术包括 59 例全胃切除术和 71 例胃大部切除术。从手术记录和病理报告中评估了手术标本在病理检查前的处理情况。评估了检查的淋巴结数量与其他变量的关系，并进行了多变量生存分析，以探讨疾病特异性生存的独立预后因素。
与未进行干预的标本相比，在病理评估前将淋巴结站分开进行解剖可获得显著更多数量的检查淋巴结（中位数 34.5 比 21.0，p<0.001）。pT 分期、pN 分期和淋巴结清扫范围被确定为独立的预后因素，而解剖标本的淋巴结站与生存无关。
将淋巴结站分开进行解剖可获得更多数量的检查淋巴结，这有可能导致更可靠的 pN 分期评估。
