Optimal extent of lymph node dissection for T1 gastric cancer, with special reference to the distribution of micrometastasis, and accuracy of preoperative diagnosis for wall invasion.
Optimal extent of lymph node dissection for T1 gastric cancer, with special reference to the distribution of micrometastasis, and accuracy of preoperative diagnosis for wall invasion.
复制标题
T1期胃癌淋巴结清扫的最佳范围，特别考虑微转移的分布以及术前诊断壁侵犯的准确性。
作者：
N. Kojima;Y. Yonemura;E. Bando;K. Morimoto;T. Kawamura;H. Yun;I. Ito;T. Kameya;I. Hayashi
背景/目的
T1期胃癌术前诊断胃壁浸润和淋巴结转移较困难。本文从胃壁浸润和淋巴结转移（包括微转移）的亚类分型，探讨T1期胃癌淋巴结的最佳清扫范围。
方法
184例cT 1或pT 1胃癌患者进行了研究。通过内窥镜和计算机断层扫描或术中发现来诊断临床壁浸润（cT）和临床淋巴结状态（cN）。用苏木精-伊红染色和免疫组化（IHC）研究淋巴结转移（pN）。
结果
在79个cM肿瘤中，60个（75.9%）被诊断为pM。在88例cSM肿瘤中，42例（47.7%）被诊断为pSM。在94 pM胃癌中，在2名患者（2.1%）和N1站中发现了微转移。70例pSM癌中有2例（1.9%）在第7、8a和12 a站有微转移。淋巴结转移（pN）与肿瘤浸润深度、淋巴管浸润和静脉浸润密切相关。在pN 2站，94例pM肿瘤中有1例（1.1%）在7号站发生淋巴结转移，70例pSM肿瘤中有9例（12.9%）在7号、8a、11 p、12 a和14 v站发生淋巴结转移。所有8例pN+/cM肿瘤均被诊断为nN 0，23例pN+/cSM肿瘤中有4例（1.4%）被正确诊断为pN+。相比之下，81例cN 0/cM肿瘤中8例（9.9%）和79例cN 0/cSM肿瘤中19例（24.1%）有组织学淋巴结转移（pN+）。
结论
临床诊断淋巴结转移的准确性很低。因此，即使对于cT 1和cN 0肿瘤，也建议进行预防性淋巴结清扫。对于cN 0/cM癌症，推荐D1+No.7。对于位于U或M区的cSM癌，建议D1+No.7、8a、9、11 p，对于位于L区的cSM癌，建议额外解剖No.14v。
BACKGROUND/AIMS
Preoperative diagnosis for wall invasion and lymph node metastasis is sometimes difficult in T1 gastric cancer. Optimum dissection extent of lymph nodes for T1 gastric cancer was studied from the aspect of subclassification of wall invasion and lymph node metastasis including micrometastasis.
METHODOLOGY
184 patients with cT1 or pT1 gastric cancer were studied. The grade of clinical wall invasion (cT) and clinical lymph node status (cN) were diagnosed by endoscopy and computed tomography or intraoperative findings. Lymph node metastasis (pN) was studied by hematoxylin and eosin staining and immunohistochemistry (IHC).
RESULTS
In 79 cM tumors, 60 (75.9%) were diagnosed as pM. In 88 cSM tumors, 42 (47.7%) were diagnosed as pSM. In 94 pM gastric cancers, micrometastases were found in two patients (2.1%) and in N1 stations. Two (1.9%) of 70 pSM cancers had micrometastasis in No. 7, 8a and 12a stations. Lymph node metastasis (pN) correlated significantly with the depth of tumor invasion, lymphatic invasion and venous invasion. Regarding the pN2 stations, one (1.1%) of 94 pM tumors had lymph node metastasis in No.7 station, and 9 (12.9%) of 70 pSM tumors had nodal involvement in No.7, 8a, 11p, 12a and 14v stations. All eight pN+/cM tumors were diagnosed as nN0 and four (1.4%) of 23 pN+/cSM tumors were correctly diagnosed as pN+. In contrast, 8 (9.9%) of 81 cN0/cM tumors and 19 (24.1%) of 79 cN0/cSM tumors had histological lymph node metastasis (pN+).
CONCLUSIONS
Accuracy of the clinical diagnosis of lymph node metastasis is very low. Accordingly, prophylactic lymph node dissection is recommended even for cT1 and cN0 tumors. For cN0/cM cancer, D1+No.7 is recommended. D1+No.7, 8a, 9, 11p is recommended for cSM cancer, located in U or M region and additional dissection of No. 14v is recommended for cSM cancer located in L region.