伴有No.16淋巴结转移胃癌治疗策略

Management strategies for gastric cancer with No.16 station lymph nodes metastases

拟行No.16淋巴结清扫的胃癌病人须行充分的术前评估及术前分期,经过多学科讨论决定个体化治疗方案。目前,预防性No.16淋巴结清扫的临床意义已被否定,治疗性No.16淋巴结清扫目前仍有争议。其指征包括无其他非根治因素及No.16淋巴结转移不超过3枚。手术多采用右侧入路(右侧Toldts间隙),清扫范围主要集中于No.16a2和b1区。No.16淋巴结清扫并不增加手术并发症发生率,但术者需具有丰富的D2淋巴结清扫和扩大淋巴结清扫经验。新辅助化疗可使肿瘤降期,增加R0手术的机会。

Cases with gastric cancer intending to perform No.16 station lymph node dissection should be perfomred adequate preoperative assesement and staging. Multiple disciplinary team discussion is needed for individualized therapeutic strategy. The clinical impact of preventive No.16 station lymph node dissection is denied. However, the effect of therapertic No.16 station lymph node dissection is still controversial. The operative indications include cases without other non-radical factors and the number of metastatic No.16 station lymph nodes no more than 3. The right approach is the most common used （in the right Toldts interval）. The dissection area is in the No.16a2 and bl regions. No.16 station lymph node dissection will not increase surgical complications, which need the surgeon should have rich experience in D2 lymphadenectomy and extensive lymphadenectomy. Neoadjuvant chemotherapy can make tumor down stage and increase the incidence of R0 resection.