Keighley M R, Moore J, Roginski C, Powell J, Thompson H
Br J Surg. 1984 Nov;71(11):863-6. doi: 10.1002/bjs.1800711121.
We have undertaken a prospective study of the frequency and prognosis associated with N4 node metastases in gastric cancer in 136 patients referred for surgical treatment between 1976 and 1983. N4 node metastases (pre-aortic or hepatic hilar nodes) were present in 20 of 31 patients who had a laparotomy without resection (64 per cent), in 2 of 8 patients who had a 'palliative' resection in the presence of distant metastases (25 per cent) and, in 19 of 85 patients who had a 'curative' resection (22 per cent). The median survival in patients having a 'curative' resection with N4 nodes was 4.5 months which was only marginally longer than in patients having a 'palliative' resection (median survival 3 months). In view of these findings and since immediate imprint cytology can be used to detect nodal metastases at operation, involvement of N4 nodes might be a contra-indication to extensive gastric resection in non-obstructing gastric cancer.
我们对1976年至1983年间接受手术治疗的136例胃癌患者中N4淋巴结转移的频率和预后进行了前瞻性研究。在31例接受剖腹探查但未行切除术的患者中，有20例存在N4淋巴结转移（主动脉前或肝门淋巴结，64%）；在8例存在远处转移而行“姑息性”切除术的患者中，有2例出现N4淋巴结转移（25%）；在85例接受“根治性”切除术的患者中，有19例出现N4淋巴结转移（22%）。有N4淋巴结转移的患者接受“根治性”切除术后的中位生存期为4.5个月，仅略长于接受“姑息性”切除术的患者（中位生存期3个月）。鉴于这些发现，并且由于术中即刻印片细胞学检查可用于检测淋巴结转移，对于非梗阻性胃癌，N4淋巴结受累可能是广泛胃切除术的禁忌证。
