Crucitti F, Pacelli F, Doglietto G B, Crucitti P, Alfieri S, Caprino P
Clinica Chirurgica dell'Università Cattolica del Sacro Cuore, Roma.
Chir Ital. 1997;49(3):21-6.
The review of the literature shows the improvement of outcome of patients with gastric cancer after resection and extended lymphadenectomy. Lymphadenectomy D2/D3 was performed in 206 out of 639 patients with gastric cancer: 5-year survival was 66.3% versus 41.5% of the 121 patients that underwent D1 resection (p < 0.0001). Univariate and multivariate analyses show that proximal location of the cancer, advanced stage and lymphadenectomy limited to perigastric stations are negative prognostic factors. Although there are still different opinions regarding D2 or D3 lymphadenectomies for the operative risks, pancreatic resection (preferring pancreas sparing techniques) and splenectomy is subtotal gastrectomy for antral carcinoma, extended lymphadenectomy remains an important point to improve survival.
文献回顾显示，胃癌患者行切除及扩大淋巴结清扫术后预后有所改善。639例胃癌患者中有206例行D2/D3淋巴结清扫术：5年生存率为66.3%，而121例行D1切除术的患者5年生存率为41.5%（p<0.0001）。单因素和多因素分析表明，肿瘤近端位置、晚期以及仅限于胃周区域的淋巴结清扫是不良预后因素。尽管对于D2或D3淋巴结清扫术的手术风险、胰腺癌切除术（倾向于保留胰腺技术）以及胃窦癌行胃次全切除术时脾切除术仍存在不同观点，但扩大淋巴结清扫术仍是提高生存率的重要环节。
