进展期远端胃癌行扩大淋巴结清扫术的研究进展

淋巴结清扫范围一直是胃癌外科的热点问题。D2根治术作为进展期胃癌标准手术已达成共识，然而扩大淋巴结清扫的价值依然存在争议。进展期远端胃癌第14v组淋巴结转移率较高，D2+14v组淋巴结清扫有可能改善第6组淋巴结明显转移患者预后；尽管胃癌腹主动脉旁淋巴结转移视为M1，但D2+16a2/b1淋巴结清扫对局限性第16组淋巴结转移患者可能获益；而D2+13组淋巴结清扫有可能提高伴有十二指肠浸润胃癌患者生存率。本文旨在探讨扩大淋巴结清扫在胃癌中的价值，以期为临床提供依据，现就进展期远端胃癌扩大淋巴结清扫的研究进展进行综述。 

Progress of extended lymphadenectomy in advanced distal gastric cancer

The extent of lymph node dissection has been a relevant issue in gastric cancer surgery. Although D2 lymphadenectomy has been increasingly regarded as the standard surgical procedure for advanced gastric cancer, the dispute exists in whether extended lymphadenectomy can bring more survival benefit. The metastatic rate of No.14v lymph nodes is relatively high in advanced distal gastric cancer. D2 plus No.14v lymph node dissection may contribute to improved survival for gastric cancer patients with obvious No.6 lymph node metastasis. Although gastric cancer with para-aortic lymph node metastasis is considered as M1 disease beyond surgical cure, several studies revealed that these patients may benefit from D2 plus No.16a2/b1 lymph node dissection. D2 plus No.13 lymphadenectomy may be an option in a potentially curative gastrectomy for tumors invading the duodenum. The purpose of this article is to explore the value of extended lymph node dissection in gastric cancer and to provide the basis for extended lymph node dissection. The progress of extended lymph node dissection in advanced distal gastric cancer is reviewed in this article.