Keller E, Stützer H, Heitmann K, Bauer P, Gebbensleben B, Rohde H
Department of Surgery, Allgemeines Krankenhaus Hamburg-Heidberg, Germany.
J Am Coll Surg. 1994 Jan;178(1):38-46.
The incidence of surgically suspected and microscopically proved lymph nodes from adenocarcinoma of the stomach and the results of systematic lymphadenectomy have been studied and correlated to survival rate of 99.4 percent at a follow-up period of five years in 872 patients who underwent resection as a part of a prospective observational study in carcinoma of the proximal and distal parts of the stomach. Surgeons believe that, in the median, only one-fifth of the patients with and without systematic lymphadenectomy had positive nodes, whereas pathologists found almost three-fourths of positive lymph nodes (72.7 percent) in patients with proximal carcinoma of the stomach as compared with those without systematic lymphadenectomy (30.8 percent). The figures for middle and lower third carcinomas were even higher (63.5 versus 13.9 percent and 75.9 versus 27.1 percent). Positive nodes were most common in the perigastric area and their distribution was clearly related to the site of the tumor. Frequently, however, lymph node groups were involved, far from the primary, that is, along the hepatoduodenal ligament in 9 to 19 percent of patients with carcinoma of the proximal part of the stomach and in 7 to 16 percent of patients with carcinoma of the distal part of the stomach. There were some hints of a better survival rate for patients with systematic lymphadenectomy as compared with those without, only for low stage carcinoma of the stomach (TNM stage IA-IB, p = 0.1157, Breslow). We suggest a more extensive operation with gastric resection, always combined with systematic lymphadenectomy if no distant metastases are found.
对872例接受胃近端和远端癌前瞻性观察性研究切除手术患者的手术怀疑及显微镜证实的胃癌淋巴结发生率以及系统性淋巴结清扫结果进行了研究，并与随访五年生存率99.4%相关联。外科医生认为，平均而言，无论是否进行系统性淋巴结清扫，只有五分之一的患者有阳性淋巴结，而病理学家发现，与未进行系统性淋巴结清扫的患者（30.8%）相比，胃近端癌患者中近四分之三（72.7%）有阳性淋巴结。胃中三分之一和下三分之一癌的这一数字更高（分别为63.5%对13.9%和75.9%对27.1%）。阳性淋巴结在胃周区域最为常见，其分布与肿瘤部位明显相关。然而，通常会有远离原发灶的淋巴结组受累，即胃近端癌患者中有9%至19%、胃远端癌患者中有7%至16%的患者沿肝十二指肠韧带出现淋巴结受累。仅对于低分期胃癌（TNM分期IA - IB，p = 0.1157，布雷斯洛），有迹象表明进行系统性淋巴结清扫的患者比未进行清扫的患者生存率更高。我们建议，如果未发现远处转移，应进行更广泛的胃切除手术，并始终结合系统性淋巴结清扫。
