General Pattern of Lymph Node Metastasis in Early Gastric Carcinoma
General Pattern of Lymph Node Metastasis in Early Gastric Carcinoma
复制标题
早期胃癌淋巴结转移的一般规律
DOI：
10.1007/s002689900151
复制
发表时间：
1996
影响因子：
2.6
通讯作者：
J. Uchino
中科院分区：
文献类型：
--
作者：
T. Namieno;K. Koito;T. Higashi;N. Sato;J. Uchino
一个可靠的方法来识别淋巴结转移是必不可少的主治医生建议不太广泛的治疗早期胃癌。在此，我们回顾了1137例单一原发病灶的连续患者，并研究了淋巴结受累的发生率和分布与病理结果的相关性。转移的总发生率为9.5%：粘膜癌为2.6%，粘膜下癌为16.5%，有显著差异。肉眼可见的混合型、显微镜下可见的弥漫型和大尺寸的病灶转移发生率最高。受累淋巴结最常见于胃小弯和胃大弯沿着的胃周淋巴结，并且与肿瘤位置、肉眼可见的凹陷/混合型、癌深度和组织学密切相关。弥漫型癌最容易转移到远处淋巴结。早期胃癌与进展期胃癌的淋巴结分布相似。本系列中的粘膜下癌没有进行不太广泛治疗的指征，如内镜或腹腔镜有限手术。这些癌应接受标准手术，包括胃切除术和联合淋巴结清扫，特别是1号和3 - 8号淋巴结。粘膜癌有时累及胃周淋巴结，此类病例行胃切除术和1、3 ~ 7号淋巴结清扫术。粘液癌10 mm或更小的淋巴结转移阴性，并被认为适合于不太广泛的治疗。
A reliable method for recognizing lymph node metastasis is indispensable for the attending physician to recommend less extensive treatment for early gastric carcinoma. Here we review 1137 consecutive patients with a single primary lesion, and the incidence and distribution of nodal involvement were investigated for correlations with pathologic findings. The overall incidence of metastasis was 9.5%: 2.6% for mucosal and 16.5% for submucosal carcinomas, a significant difference. The occurrence of metastasis was highest for lesions of the macroscopically mixed type, microscopically diffuse type, and large size. The involved nodes were most frequently found in the perigastric nodes along the lesser and greater curvatures, and it was well correlated with the tumor location, macroscopically depressed/mixed type, cancer depth, and histology. The diffuse-type carcinomas were most likely to metastasize to distant nodes. The distribution of involved nodes for early gastric carcinoma was similar to that for advanced carcinoma, as previously been reported. The submucosal carcinomas in this series had no indications for less extensive treatment, such as endoscopic or laparoscopic limited surgery. These carcinomas should be subject to standard surgery with gastrectomy and combined dissection of lymph nodes, especially node stations 1 and 3 to 8. The mucosal carcinomas sometimes involved the perigastric nodes, and such cases underwent gastrectomy and lymphadenectomy of node stations 1 and 3 to 7. Mucosal carcinomas 10 mm or less in size were negative for lymph node metastasis and were considered appropriate for less extensive treatment.