进展期胃癌腹主动脉旁淋巴结清扫术研究

目的 探讨进展期胃癌患者施行腹主动脉旁淋巴结（N16）清扫手术的必要性及手术适应证。方法 通过对36例进展期胃癌患者行腹主动脉旁淋巴结（N16）清扫术，分析影响腹主动脉旁淋巴结转移的临床病理因素，并与同期进行的D2手术50例进行手术创伤程度、并发症及术后生活质量比较。结果 腹主动脉旁淋巴结出现转移与肿瘤浸润深度、组织学类型及其他各组淋巴在T3，T4及低分化腺癌的进展期胃癌患者，腹主动脉旁淋巴结应纳入清扫范围之内。     

进展期胃癌淋巴结清扫范围探讨

目的 探讨进展期胃癌淋巴结清扫范围的合理性。方法 对６７例进展期胃癌患者施行了包括第１６组淋巴结清扫在内的扩大根治术。结果 Ｎ１淋巴结转移发生率为９２．５％、Ｎ２为６２．７％、Ｎ３为３１．３％、第１６组也达到２３．９％。结论 作者复习有关文献,分析此组资料认为对进展期胃癌肿瘤侵犯浆膜层,肿瘤范围较大,ＢｏｒｒｍａｎｎⅡ、Ⅲ型,组织分化不良以及Ｎ１、Ｎ２淋巴结转移较多的患者应选择施行包括第１６组淋巴     

淋巴结清扫范围对进展期胃癌患者预后的影响研究

目的探讨不同淋巴结清扫方案对进展期胃癌患者预后的影响。方法选取267例进展期胃癌患者,所有患者均接受D1或D2淋巴结清扫术。分析淋巴结转移与进展期胃癌患者临床特征的关系,并对不同淋巴结清扫术后胃癌患者的生存情况进行分析。结果不同性别、年龄、肿瘤部位进展期胃癌患者的淋巴结转移率比较,差异均无统计学意义(P>0.05);不同肿瘤最大径、Borrmann分型、TNM分期、分化程度进展期胃癌患者的淋巴结转移率比较,差异均有统计学意义(P<0.05)。行D2淋巴结清扫术的进展期胃癌患者的中位生存时间为55.0个月(95%CI:51.1～58.9),明显长于行D1淋巴结清扫术患者的28.5个月(95%CI:21.3～34.7)(P<0.01)。结论肿瘤最大径、Borrmann分型、TNM分期及分化程度可能影响进展期胃癌患者的淋巴结转移情况,而D2淋巴结清扫术后进展期胃癌患者能获得更长的生存期。     

胃癌淋巴结清扫范围的现状与进展

我国因胃癌死亡的人数居恶性肿瘤之首[1],关于胃癌的研究已经成为了全社会关注的热点问题.胃癌一般分为早期胃癌与进展期胃癌,淋巴结转移是胃癌的主要转移途径,因此胃癌淋巴结清扫范围与预后直接相关.近年来,随着研究的深入,胃癌的手术方式及淋巴结清扫受到人们的重视,但淋巴结清扫范围一直存在争论[2-3].本文对胃癌淋巴结清扫的现状与进展加以综述.     

胃癌的淋巴结转移与清扫范围关系的探讨

目的:探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义.方法:收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系.结果:103例患者胃癌淋巴结转移率为68.9%(71/103).随着肿瘤直径的增加,淋巴结转移率(度)也增高(P<0.05);临床分期中,胃癌的淋巴结转移率(度)随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率(度)均低于其它期 (P<0.01);Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%(40/49),高于其它型(P<0.05),而Ⅳ型患者淋巴结转移度32.4%(161/497)最高.结论:淋巴结转移率和转移度随着胃癌的临床进展而增高.合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性.     

胃癌的淋巴结转移与清扫范围关系的探讨

目的：探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义。方法：收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系。结果：103例患者胃癌淋巴结转移率为68.9%（71/103）。随着肿瘤直径的增加,淋巴结转移率（度）也增高（P〈0.05）;临床分期中,胃癌的淋巴结转移率（度）随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率（度）均低于其它期（P〈0.01）;Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%（40/49）,高于其它型（P〈0.05）,而Ⅳ型患者淋巴结转移度32.4%（161/497）最高。结论：淋巴结转移率和转移度随着胃癌的临床进展而增高。合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性。     

进展期胆囊癌区域化淋巴结清扫临床研究

目的探讨进展期胆囊癌区域化淋巴结清扫的方法和意义。方法回顾性分析226例确诊为进展期胆囊癌患者的临床资料,收集患者的临床资料并进行整理分析,并对患者进行随访,分析进展期胆囊癌区域化淋巴结清扫的特点及手术方法。结果 226例患者中,男性71例,女性155例,平均年龄(63.5±13.2)岁,中位年龄65岁,大部分患者胆囊有既往病史,且表现出一种或数种胆囊癌的临床症状;B超检查诊断率为51.82%;CT检查诊断率为72.19%;B超联合CT检查,诊断率为81.46%;肿瘤标志物CA199升高比例为73.89%;CA125升高比例为56.64%;CEA升高比例为38.94%;上述任意一种肿瘤标志物升高比例为91.15%;胆囊癌根治术平均淋巴结清扫个数为(9.51±3.50)个,中位个数为8个;保守治疗者术后生存时间为(16.56±3.46)个月;手术治疗者术后生存时间为(21.51±5.46)个月,两者术后生存时间比较无统计学差异(P>0.05)。结论胆囊癌根治术时,可将第八和第十三组淋巴结连同肝十二指肠韧带周围淋巴结一并清除。     

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。      

自下向上入路开放式远端胃癌D2淋巴结清扫术

目的 探讨自下向上入路开放式远端胃癌D2淋巴结清扫术的可行性.方法 选取武鸣县人民医院自2012年3月至2013年5月收治的36例确诊为进展期远端胃癌患者,采取自下向上入路进行开放式D2淋巴结清扫术,记录手术时间、术中出血量、淋巴结清扫数目,观察术后并发症情况并进行随访.结果 36例均成功完成手术.术中出血量50～220 mL,平均120 mL;淋巴结清扫数目12～37个,平均24个.术后1例出现淋巴漏并发症,1例出现腹腔出血并发症,经治疗后均痊愈出院;随访1~15个月,无局部复发病例,1例骨转移,无死亡病例.结论 自下向上入路开放式远端胃癌D2淋巴结清扫术是一种安全可行的手术方式.     

胃癌手术的淋巴结清扫范围

综述胃癌手术的历史变迁，尤其是胃癌手术淋巴结清扫从无到有从小到大再到适中的过程，认为胃癌合理根治手术范围是胃切除和淋巴结清扫范围恰如其分，即以力争根治为前提，同时注意到维持或改进患者生活质量。     

Prognostic factors for noncurative gastric cancer: univariate and multivariate analyses.

We performed univariate and multivariate analyses of possible prognostic factors related to postoperative clinical course of patients with advanced gastric cancer. Noncurative resection was done for 119 patients with hepatic metastasis, peritoneal seeding, extensive lymph node metastasis, or direct invasion to adjacent organs, either alone or in various combinations. In the univariate analysis, 6 of 17 items such as peritoneal seeding, lymphatic invasion, vascular invasion, mode of invasion, extent of lymphadenectomy, and width of serosal invasion significantly correlated to the prognosis. The multivariate analysis indicated that three inherent pathologic factors, mode of invasion, lymph node metastasis, and hepatic metastasis, and one treatment factor, extent of lymphadenectomy, were significant variables predictive of the prognosis and that the prognosis was expected to be very poor in cases of infiltrative type, nodal involvement to tertiary nodes, presence of hepatic metastasis, and lymphadenectomy less than R3. Prognosis in terms of the extent of lymphadenectomy shows that extensive lymphadenectomy (R3) proved to be significantly effective in prolonging survival time, even after noncurative gastrectomy. We recommend extensive lymphadenectomy to prolong survival time for such patients.     

Over-DI dissection may question the value of radiotherapy as a part of an adjuvant programme in high-risk radically resected gastric cancer patients

The aim of our analysis was to assess retrospectively the effect on local relapse, overall survival (OS) and disease-free survival (DFS) of a limited or an extended lymphadenectomy in radically resected gastric cancer patients. This study was performed in order to identify a subgroup of patients possibly not benefiting from a therapeutic approach such as chemoradiation therapy. We divided our patients into two groups according to lymphadenectomy type: group A for limited (<25 resected lymph nodes) and group B for extended (>25 resected lymph nodes) lymph nodes resection. A total of 418 patients were analysed: tumour stage at diagnosis was pT2-3 pN1-3 M0 in 339 patients and pT3 N0 M0 in 79 patients. Median age at diagnosis was 68 years (range 30-92 years). A total of 306 patients (73.2%) were in group A and 112 (26.8%) in group B. The median survival time (OS) for patients in groups A and B was 58.8 and 84.8 months, respectively (P=0.0371); median DFS was 28.8 months in group A and 59.9 months in group B (P=0.0027). At multivariate analysis, extension within the gastric wall, nodal involvement and the number of resected lymph nodes appeared to affect both OS and DFS. An inadequate lymph nodes resection can affect survival and result in a higher incidence of local relapse, making the latter group of patients optimal candidates for adjuvant chemoradiation.     

The extent of lymph node dissection for gastric cancer: a critical appraisal

The extent of lymphadenectomy during therapeutic gastrectomy for gastric cancer remains a protracted and controversial issue. While traditionally extended lymphadenectomy is performed in Eastern Asia, limited lymphadenectomy is advocated by most western surgeons. Two large western randomized trials, meta-analyses and a recent systematic review were unable to demonstrate overall benefit from extended lymphadenectomy. In this review, the currently available data on this topic are critically evaluated, while ongoing studies and future perspective are discussed.     

D2 Lymphadenectomy in Gastric Cancer Surgery

Gastric cancer is one of the most common causes of cancer death worldwide. Surgery is the most widely utilized treatment for resectable gastric cancer. Evidence indicates that lymph node involvement and depth of invasion of the primary tumor are the most important prognostic factors for gastric cancer patients. Therefore, lymph node clearance is deemed a key procedure in gastric cancer surgery for the prognostic value to patients. Although the appropriate lymphadenectomy during gastrectomy for cancer still remains controversial, extended lymph node dissection (D2 lymphadenectomy) should be recommended in high volume hospitals.     

D2 lymphadenectomy in gastric cancer surgery

Gastric cancer is one of the most common causes of cancer death worldwide. Surgery is the most widely utilized treatment for resectable gastric cancer. Evidence indicates that lymph node involvement and depth of invasion of the primary tumor are the most important prognostic factors for gastric cancer patients. Therefore, lymph node clearance is deemed a key procedure in gastric cancer surgery for the prognostic value to patients. Although the appropriate lymphadenectomy during gastrectomy for cancer still remains controversial, extended lymph node dissection （D2 lymphadenectomy） should be recommended in high volume hospitals.     

Extended lymph node dissection without routine spleno-pancreatectomy for treatment of gastric cancer: low morbidity and mortality rates in a single center series of 250 patients

BACKGROUND AND OBJECTIVES: To verify the hypothesis that avoidance of routine splenectomy and distal pancreatectomy in a modified D-2 resection for gastric cancer can significantly lower the complications rate of this procedure in a population of Western patients. METHODS: A series of 250 consecutive Italian patients suffering from localized, histology-proven gastric cancer was submitted to gastrectomy and extended D-2 lymphadenectomy for treatment of their disease during an 8-year period (1994-2002) at the European Institute of Oncology in Milano, Italy. Caudal pancreas and spleen were routinely preserved, unless the tumor was not closely adjacent to or directly invading these organs. Postoperative morbidity, overall mortality, and length of hospital stay were recorded. RESULTS: One hundred forty patients underwent total gastrectomy and 110 a subtotal distal one; splenectomy was performed in 8 cases and spleno-pancreatectomy in 15. The postoperative morbidity rate was 18%, the mortality rate was 1.2% and 9 patients experienced re-operation. The median length of stay was 14.8 days. CONCLUSIONS: These results compete favorably with those reported after standard D-1 gastrectomy in Western patients series. D-2 gastrectomy with spleen and pancreas routine preservation can be considered a safe treatment for gastric cancer in Western patients, at least in experienced centers.