Lymphadenectomy around the left renal vein in Siewert type II adenocarcinoma of the oesophagogastric junction
Lymphadenectomy around the left renal vein in Siewert type II adenocarcinoma of the oesophagogastric junction
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DOI：
10.1002/bjs.8967
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发表时间：
2013-01-01
影响因子：
9.6
通讯作者：
Yamaguchi, T.
中科院分区：
文献类型：
--
作者：
Mine, S.;Sano, T.;Yamaguchi, T.
背景：食管胃交界处Siewert II型腺癌患者的淋巴结切除范围存在争议。本研究的目的是调查左肾静脉周围淋巴结受累。研究方法：研究了经R 01手术切除治疗的Siewert II型癌症患者的淋巴结受累和预后，涉及左肾静脉周围淋巴结切除术。根据每个节点的参与率，将节点台站分为三级（第一级，参与率超过20%;第二级，参与率为10 - 20%;第三级，参与率低于10%）。结果：150例II型食管胃腺癌患者中，94例接受了左肾静脉淋巴结清扫术。第一层淋巴结包括胃小弯、右贲门、左贲门及胃左动脉旁沿着淋巴结，淋巴结转移率为28.046.0%，阳性者5年生存率为42.53%。下纵隔周围淋巴结、左肾静脉、脾动脉、腹腔轴为第二层，受累率12.718%，5年生存率11.35%。参与的发生率为17%，多因素分析显示，左肾静脉淋巴结清扫术是病理性T34肿瘤患者的独立预后因素（风险比0.51，95%置信区间0.26至0.99; P = 0.048）。结论：左肾静脉淋巴结受累与沿着脾动脉、下纵隔和腹腔轴的受累相似，对患者生存率的影响相似。版权所有（C）2012英国外科学会杂志有限公司由约翰威利父子有限公司出版。
Background: The extent of lymphadenectomy in patients with Siewert type II adenocarcinoma of the oesophagogastric junction is controversial. The aim of this study was to investigate lymph node involvement around the left renal vein. Methods: Lymph node involvement and prognosis in patients with Siewert type II cancers treated by R01 surgical resection were investigated, with regard to lymphadenectomy around the left renal vein. Based on the incidence of involvement at each node, the node stations were divided into three tiers (first tier, more than 20 per cent involvement; second tier, 1020 per cent involvement; third tier, less than 10 per cent involvement). Results: Of 150 patients with type II oesophagogastric adenocarcinoma, 94 had left renal vein lymphadenectomy. The first lymph node tier included nodes along the lesser curvature, right cardia, left cardia and left gastric artery, with involvement of 28.046.0 per cent and a 5-year survival rate of 4253 per cent in patients with positive nodes. The nodes around the lower mediastinum, left renal vein, splenic artery and coeliac axis constituted the second tier, with involvement of 12.718 per cent and a 5-year survival rate of 1135 per cent. With regard to the left renal vein, the incidence of involvement was 17 per cent and the 5-year rate survival rate was 19 per cent. Multivariable analysis showed that left renal vein lymphadenectomy was an independent prognostic factor in patients with pathological tumour category pathological T34 disease (hazard ratio 0.51, 95 per cent confidence interval 0.26 to 0.99; P = 0.048). Conclusion: Left renal vein nodal involvement is similar to that seen along the splenic artery, in the lower mediastinum and coeliac axis, with similar impact on patient survival. Copyright (C) 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.