胃食管结合部腺癌区域淋巴廓清的临床研究

Retrospective study of lymphadenectomy for the esophagogastric junction adenocarcinoma

目的探讨胃型胃食管结合部腺癌淋巴清扫范围与淋巴结转移区域分布规律。方法分析2004年1月至2015年12月,山西省人民医院普外科收治的胃食管结合部癌患者肿瘤数据库,基于Nishi分型选取其中胃型胃食管结合部腺癌肿瘤,直径≤40 mm并R0切除患者相关肿瘤学数据勾勒胃型胃食管结合部腺癌淋巴高频转移站别区域图。结果纳入306例胃型胃食管结合部腺癌患者,结果显示:pT4期肿瘤占87%、pN阳性占77. 8%、pTNM分期Ⅲ期占74. 5%;肿瘤直径(25. 44±18. 03)mm;腹腔淋巴结转移高频区域依次是贲门左右侧(第1、2组)、小弯侧胃左血管周围(第3组)、胰腺上缘腹腔干(第9组)及其主干分支胃左动脉(第7组)、肝总动脉(第8a组)、脾动脉近端(第11p组)、肝动脉(第12a组)周围以及食管裂孔周围(第19、20组);胃远端区域转移较为罕见。结论瘤体直径≤40 mm胃型胃食管结合部腺癌淋巴清扫区域应集中在贲门左右侧、小弯侧、胰腺上缘腹腔干及其主干分支以及食管裂孔周围,胃远端及大弯侧区域淋巴清扫外科获益价值存疑。

Objective To determine the optimal lymphadenectomy of the esophagogastric junction adenocarcinoma(EGJ)according to the distribution of lymph node metastasis.Methods Using a multicenter data set,clinical records from the patients with stomach-predominant EGJ adenocarcinoma according to Nishi s classification,less than40mm in diameter,who underwent R0resection in the authors affiliated hospital between2004and2015were reviewed to determine the distribution of lymphatic metastasis.Results A group of306patients with the stomach-predominant EGJ adenocarcinoma were included in the analysis,with87%of pT4tumors,77.8%of lymph node metastasis and74.5%ofⅢA-ⅢB.Mean tumor size was(25.44±18.03)mm.The lymphatic spread in patients who had stomach-predominant adenocarcinoma differed frequently in the involved abdominal lymph node stations.The predominating stations of lymph node metastases were left and right paracardial lymph nodes(No.1and2),lesser curvature lymph nodes(No.3),nodes along the common hepatic artery(No.8a),lymph nodes along the celiac artery(No.9),lymph nodes along the proximal splenic artery(No.11p),lymph nodes in the hepatoduodenal ligament(No.12)and parahiatal lymph nodes(No.19and20).Nodes along the distal portion of the stomach were much less often metastatic.Conclusions The priority nodal stations to lymphadenectomy were the paracardial and lesser curvature nodes,nodes around celiac trunk and its main branches,and parahiatal lymph nodes.The benefits of lymph node dissection along the distal portion of the stomach remain issues to be addressed in most stomach-predominant EGJ adenocarcinoma less than40mm.