Giedl J, Hermanek P, Husemann B
Langenbecks Arch Chir. 1980;350(3):191-7. doi: 10.1007/BF01237560.
Incidence and distribution of lymph node metastases were examined in 100 gastrectomy specimens with 104 primary gastric carcinomas. Special emphasis was placed on the correlation with the location of the tumor and its size as well as the depth of infiltration and the tumor histology. Sixty-one percent of carcinomas with a diameter of up to 6 cm had lymph node metastases while this was the case in 83% of larger tumors. Infiltration of the muscularis propria only was associated with a 23% incidence of lymphogeneous metastases. This figure rose to 75% if the tumor reached the subserosa. Carcinomas of the diffuse (Lauren) or infiltrating (Ming) type show metastases more frequently (83% and 81% respectively) than those of the intestinal or expansive type (58%). In addition, several regions of lymphatic drainage are more frequently involved with the diffuse type. In only 2 patients (2% of all patients or 3% of the patients with lymphogeneous metastases) skipping of lymph nodes could be observed. In all other patients distant lymph nodes showed metastases only if the perigastric nodes next to the tumor were involved also. These findings support a differentiated, stage- and histology-dependent surgery.
对100例胃切除术标本中的104例原发性胃癌进行了淋巴结转移的发生率和分布情况的检查。特别强调了与肿瘤位置、大小、浸润深度以及肿瘤组织学的相关性。直径达6 cm的癌中，61%有淋巴结转移，而较大肿瘤的这一比例为83%。仅侵犯固有肌层的癌发生淋巴转移的发生率为23%。如果肿瘤累及浆膜下层，这一数字升至75%。弥漫型（劳伦分型）或浸润型（明分型）癌比肠型或膨胀型癌更易发生转移（分别为83%和81%比58%）。此外，弥漫型癌的几个淋巴引流区域更常受累。仅在2例患者中（占所有患者的2%或淋巴转移患者的3%）观察到淋巴结跳跃转移。在所有其他患者中，只有肿瘤旁的胃周淋巴结受累时，远处淋巴结才会出现转移。这些发现支持了一种基于分期和组织学的个体化手术。
