Nakane Y, Okamura S, Masuya Y, Okumura S, Akehira K, Hioki K
2nd Department of Surgery, Kansai Medical University, Osaka, Japan.
Hepatogastroenterology. 1998 Sep-Oct;45(23):1901-6.
BACKGROUND/AIMS: We investigated the frequency of para-aortic lymph node involvement and evaluated the effects on survival of dissection of these lymph nodes in patients with N4 node metastasis.
One hundred and forty nine gastric cancer patients with N4 node dissection were analyzed. Total gastrectomy with splenectomy or pancreatosplenectomy was performed in 99, distal gastrectomy 48, pancreaticoduodenectomy 3, and proximal gastrectomy with splenectomy 2.
N4 nodal involvement was found in about 30-40% of operable patients with Borrmann's type 3 or 4 tumor, with tumor >8 cm in size, with tumor throughout the entire or in the upper third of the stomach, with tumor invasion to the serosa or adjacent structures, with N2 or N3 regional lymph node metastasis, and with undifferentiated histological type. The survival was quite poor. However, in patients without N3 nodal involvement or intraperitoneal free cancer cells, the survival after resection of tumor with N4 nodal involvement was relatively favorable.
The resection of these involved lymph nodes can be expected to be beneficial in patients without extensive serosal invasion and without extensive lymph nodal involvement such as N3 nodes. Patients with tumor in the upper third of the stomach are appropriate candidates for N4 node dissection.
背景/目的：我们调查了主动脉旁淋巴结受累的频率，并评估了N4淋巴结转移患者清扫这些淋巴结对生存的影响。
对149例行N4淋巴结清扫的胃癌患者进行分析。99例行全胃切除术加脾切除术或胰脾切除术，48例行远端胃切除术，3例行胰十二指肠切除术，2例行近端胃切除术加脾切除术。
在约30% - 40%可手术的Borrmann 3型或4型肿瘤患者中发现N4淋巴结受累，这些患者肿瘤大小>8 cm，肿瘤累及整个胃或胃的上三分之一，肿瘤侵犯至浆膜或邻近结构，有N2或N3区域淋巴结转移，以及组织学类型为未分化型。其生存情况很差。然而，在无N3淋巴结受累或腹腔内无游离癌细胞的患者中，切除有N4淋巴结受累的肿瘤后的生存情况相对较好。
对于没有广泛浆膜侵犯和没有广泛淋巴结受累（如N3淋巴结）的患者，切除这些受累淋巴结有望带来益处。胃上三分之一有肿瘤的患者是N4淋巴结清扫的合适人选。
