局部进展期胃癌合理淋巴结清扫范围再探讨

Re-evaluation of the rational extent of lymphadenectomy for locally advanced gastric cancer

基于随机对照临床研究结果,D2淋巴结清扫在全球范围被推荐为标准胃癌术式。但是针对不同分期病例的精准淋巴结清扫范围仍存在争议。淋巴结清扫数目以及淋巴结外软组织转移与患者的预后密切相关。近端非大弯侧胃癌是否切脾以彻底清扫No.10淋巴结,仍等待JCOG0110研究的最终结论。No.14组淋巴结在新版日本胃癌指南中划归为M1,但是对于No.6组淋巴结转移和十二指肠受累的病例而言,D2+No.14v可能会使患者获益。JCOG9501研究由于入组病例仅包括T_(2b-3),N_(1-2)(ⅡB-ⅢA)病例,因此其结果不能证明T_3和/或N_3病例是否能从D2+PAND中获益,而这组病例在中国以及除日韩以外的国家非常多见。

On the basis of randomized clinical trials, the extended （D2） lymph node dissection is now recommended as a globally standard procedure for locally advanced gastric cancer. However, the rational extent of lymphadenectomy for locally advanced gastric can- cer has remained a topic of debate in the past decades. The examined lymph node and extra-nodal metastasis are significantly associated with the survival of gastric cancer patients. Furthermore, the role of splenectomy for complete resection of No. 10 nodes has been controversial; however, the randomized trial of JCOG0110 is yet to be completed. Gastric cancer with No. 14 lymph node metastasis is defined as M1 stage in the current version of the Japanese classification. We propose that D2＋No.14v lymphadenectomy may be an option in a potentially curative gastrectomy for tumors with apparent metastasis to the No. 6 nodes or infiltrate to duodenum. In view of the limitation of low metastatic rate in paraaortic lymph nodes in Japan Clinical Oncology Group （JCOG9501）, the clinical benefits of D2＋PAND for patients with stage T3 and/or stage N3 disease, both of which are very common in China and many other countries except Japan and Korea, cannot be determined.