Yonemura Y, Ninomiya I, Tsugawa K, Masumoto H, Takamura H, Fushida S, Yamaguchi A, Miwa K, Miyazaki I
School of Medicine, Kanazawa University, Japan.
Hepatogastroenterology. 1994 Jun;41(3):248-52.
The incidence of metastases from gastric stump cancer to various regional lymph node stations was studied after meticulous node dissection in 87 patients, who had undergone curative resection. Fifty-five (63%) patients had microscopically involved nodes. The incidence of node metastases varied between 17% and 30% in the perigastric nodes (n 1), with the same incidence in second-station lymph nodes (n 2; nodes along the left gastric, common hepatic and splenic artery, or nodes at the splenic hilus) With respect to third-station lymph nodes (n 3), metastases in nodes in the hepatoduodenal ligament (No 12) and retropancreatic nodes (No 13) were found only in 2% and 8% of the cases, respectively, but there was a high incidence of metastases (14/54, 31%) in the nodes along the mesenteric root. The overall 5-year survival rate was 48% and those for n 1 and n 2 patients were 78%, and 41%, respectively. With regard to the third level lymph node station, no 5-year survivors were seen when there was nodal involvement in node station No. 12 or No. 13. However, involvement of nodes at the root of the mesentery was associated with a 5-year survival rate of 25%. These results suggest that resection of the second level lymph nodes station must be combined with total gastrectomy and distal pancreatectomy, and that the resection of the mesenteric root is very important in patients with a tumor invading the jejunum.
对87例行根治性切除的患者进行细致的淋巴结清扫后，研究了胃残端癌转移至各区域淋巴结站的发生率。55例（63%）患者有镜下受累淋巴结。胃周淋巴结（n1）的淋巴结转移发生率在17%至30%之间，第二站淋巴结（n2；沿胃左、肝总及脾动脉的淋巴结或脾门淋巴结）的转移发生率与之相同。关于第三站淋巴结（n3），仅2%和8%的病例分别在肝十二指肠韧带（第12组）和胰后淋巴结（第13组）发现转移，但肠系膜根部淋巴结转移发生率较高（14/54，31%）。总体5年生存率为48%，n1和n2患者的5年生存率分别为78%和41%。关于第三级淋巴结站，当第12组或第13组淋巴结受累时未见5年生存者。然而，肠系膜根部淋巴结受累的患者5年生存率为25%。这些结果表明，第二站淋巴结清扫必须与全胃切除及远端胰腺切除相结合，对于肿瘤侵犯空肠的患者，肠系膜根部切除非常重要。
