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背景胃切除D2淋巴结清扫是局部进展期胃癌的标准治疗,但对于淋巴结转移率较低的早期胃癌,D2根治可能是过度治疗。术前诊断早期胃癌的准确率达92.4%-95.4%,但有4.6%-7.6%的患者术前诊断为早期胃癌,但病理事实上为进展期胃癌。此类患者需要D2淋巴结清扫,但临床上治疗通常选择了胃切除并缩小的淋巴结清扫。本研究旨在阐明这些临床上术前诊断为早期、但病理结果为进展期胃癌病例的临床病理特点以及施行缩小淋巴结清扫的可行性。资料与方法回顾性分析1528例病理诊断T2的胃癌患者的临床病理特点,包括淋巴结转移率以及常见转移部位等。T2患者根据术前分期分为两组,一组266例为术前诊断早期T1胃癌(EpT2),另一组1262例术前诊断局部进展期T2胃癌(ApT2),其中最后病理诊断证实875例T2、333例T3、54例T4胃癌。结果 EpT2组淋巴结转移数目、转移程度以及临床TNM分期都明显低于ApT2组(P<0.001)。EpT2组5年生存率为91.0%,而ApT2组仅73.1%(P<0.001)。EpT2组淋巴结转移通常限于胃周淋巴结,极少病例有No.7、No.8a、No.9转移,D1+β清扫达到足够治疗。EpT2组中,有261例(98%)施行了缩小的淋巴结清扫手术,有5例(2%)淋巴结转移超出No.7、No.8a、No.9站,但该5例患者术中都发现有明显的淋巴结肿大,并冰冻切片证实,施行了D2或扩大的淋巴结清扫。结论术前诊断早期胃癌的患者,尽管其术后病理诊断证实为T2,此类患者预后良好,手术治疗应施行缩小的淋巴结清扫,除非术中发现有明显的淋巴结转移。
Background Gastrectomy D2 lymph node dissection is the standard treatment for locally advanced gastric cancer, but for early gastric cancer with lower lymph node metastasis, radical D2 treatment may be over-treatment. The accuracy of preoperative diagnosis of early gastric cancer ranged from 92.4% to 95.4%. However, 4.6% -7.6% of patients had early diagnosis of gastric cancer preoperatively, but the pathology was actually advanced gastric cancer. Such patients require D2 lymph node dissection, but clinical treatment usually selects gastrectomy and reduced lymph node dissection. The purpose of this study was to elucidate the clinical and pathological features of these clinically preoperative diagnoses and the feasibility of minimally invasive lymphadenectomy in patients with advanced gastric cancer. Materials and Methods Retrospective analysis of 1528 cases of pathological diagnosis of T2 gastric cancer patients with clinicopathological features, including lymph node metastasis rate and common metastatic sites. T2 patients were divided into two groups according to preoperative staging, one group of 266 cases preoperative diagnosis of early T1 gastric cancer (EpT2), the other group of 1262 cases of preoperative diagnosis of locally advanced T2 gastric cancer (ApT2), of which the final pathological diagnosis confirmed 875 cases T2, 333 cases of T3, 54 cases of T4 gastric cancer. Results The number of lymph node metastasis, the degree of metastasis and the clinical TNM stage in EpT2 group were significantly lower than those in ApT2 group (P <0.001). The 5-year survival rate was 91.0% in the EpT2 group compared with 73.1% in the ApT2 group (P <0.001). EpT2 group lymph node metastasis is usually limited to the gastric lymph nodes, rarely cases No.7, No.8a, No.9 transfer, D1 + β cleaning enough treatment. Of the EpT2 group, 261 (98%) performed a reduced lymph node dissection and 5 (2%) had lymph node metastasis beyond No.7, No.8a, and No.9, Significant lymphadenectasis was found and frozen section confirmed D2 or enlarged lymph node dissection. Conclusions Patients with preoperative diagnosis of early gastric cancer, despite their postoperative pathological diagnosis confirmed as T2, have a good prognosis. Surgical treatment should be performed with reduced lymph node dissection unless significant lymph node metastases are found during the operation.