胃癌根治术后规范淋巴结送检的要点及临床意义

Clinical significance and principles of the specification procedures for lymph node examination after curative surgery for gastric cancer

淋巴结转移是反映胃癌进展程度、评估胃癌预后及指导术后治疗的最关键指标之一，以转移数目为基础的分期方式（pN分期）是目前公认最佳的胃癌根治术后淋巴结转移分期方式。自1992年以来，胃癌术后淋巴结转移分期的标准处于持续更新中，而如何保证获得淋巴结转移的准确信息却一直存有争议。淋巴结转移分期迁移现象是指转移淋巴结数目与淋巴结清扫范围大小直接成正比，而随着淋巴结清扫范围的扩大，逐渐能够降低或者避免淋巴结分期迁移的发生（也称Will-Roger现象）。分期迁移是能够明显影响胃癌根治术后病理分期、预后评估及辅助治疗策略制定的重要因素。受患者个体差异、疾病分期、肿瘤生物学行为、淋巴结清扫范围和送检淋巴结操作等多因素的影响，淋巴结转移分期的准确性在临床工作中常难以得到充分保证。在根治性胃癌淋巴结清扫的基础之上，规范淋巴结送检操作是充分掌握患者淋巴结转移信息的必要手段，也是体现高质量胃癌根治术所必不可缺的重要佐证，并将为以后胃癌的精准诊治提供详尽的数据基础。

So far, the category based on the number of metastatic lymph nodes （eg. pN stage） has been demonstrated to be the optimal staging of lymph node metastasis after curative surgery for gastric cancer. Although pN stage has been updating since 1992, it has been still controversial to guarantee the acquisition for the accurate information of lymph node metastasis from gastric cancer. Generally, stage migration of lymph node metastasis means that number of metastatic lymph node is positively correlated with the extent of lymphadenectomy, and with the expansion of lymphadenectomy extent, occurrence of stage migration of lymph node metastasis may decrease gradually or be avoided （Will-Roger phenomena） . Stage migration of lymph node metastasis is considered to have a significant impact on the pathologic stage, prognostic evaluation and strategy formulation of adjuvant therapy. Actually, stage migration of lymph node metastasis may be induced by individual difference in patients, disease stage, special biological behaviors of tumor, extent of lymphadenectomy, procedures of lymph node examination and so on, which may undermine the accurate staging of lymph node metastasis from gastric cancer in clinic. The specification procedures for lymph node examination following the radical lymphadenectomy for gastric cancer are not only the necessary method to figure out the comprehensive information of lymph node metastasis from patients but also the essential evidence to embody the high quality of curative gastrectomy for patients, which may provide the optima database for the further precise diagnosis and treatment of gastric cancer.