Kobayashi O, Onodera S, Rino Y, Okugawa T, Okada K, Sairenji M, Motohashi H
Department of Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Nihon Geka Gakkai Zasshi. 1994 Dec;95(12):860-5.
In order to improve the results of surgical treatment in advanced gastric cancer, we performed preoperative targeted chemotherapy for metastatic lymph nodes. The solution which contained aclarubicin adsorbed on activated carbon was submucously injected around gastric tumor under endoscopic observation 2-7 days prior to the operation. We termed this method medicinal lymph node dissection (MLD). Our standard surgical treatment (SST) for gastric cancer consists of gastrectomy and extended lymph node dissection (N1 and N2 lymph nodes). Patients of curative resection with histologically positive lymph node metastasis were enrolled, as the subjects. We compared the cumulative survival rate in 47 patients treated with SST+MLD (MLD group) with that in 125 patients treated with SST only (control group). Five year survival rates in the MLD and control groups were 60% and 48%, respectively. The MLD group showed significantly higher survival rate in patients with N3, N4 and infrapyloric lymph node metastasis. A significant difference of the survival rate suggests the efficacy of SST+MLD against micrometastasis in N3 and para-aortic lymph nodes. The SST+MLD therapy is recommended to the advanced gastric cancer, especially in the lower third of the stomach.
为提高进展期胃癌的手术治疗效果，我们对转移性淋巴结进行了术前靶向化疗。在手术前2 - 7天，于内镜观察下将含阿柔比星吸附于活性炭的溶液注射至胃肿瘤周围的黏膜下层。我们将此方法称为药物性淋巴结清扫（MLD）。我们对胃癌的标准手术治疗（SST）包括胃切除术和扩大淋巴结清扫（N1和N2淋巴结）。选取组织学检查淋巴结转移阳性的根治性切除患者作为研究对象。我们比较了47例接受SST + MLD治疗的患者（MLD组）与125例仅接受SST治疗的患者（对照组）的累积生存率。MLD组和对照组的五年生存率分别为60%和48%。MLD组在N3、N4及幽门下淋巴结转移患者中的生存率显著更高。生存率的显著差异表明SST + MLD对N3及腹主动脉旁淋巴结微转移有效。对于进展期胃癌，尤其是胃下1/3段的进展期胃癌，推荐采用SST + MLD治疗。
