Improving the standard of lymph node retrieval after gastric cancer surgery
Improving the standard of lymph node retrieval after gastric cancer surgery
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DOI：
10.1111/his.12167
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发表时间：
2013-09-01
期刊：
影响因子：
6.4
通讯作者：
Goldin, Robert
中科院分区：
文献类型：
--
作者：
Hanna, George B.;Amygdalos, Iakovos;Goldin, Robert
目的：为了研究影响淋巴结计数的因素，并研究淋巴结大小和转移的参与胃癌之间的关系。方法和结果：观察性研究比较淋巴结检索手动淋巴结清扫（MND）和系统脂肪阻滞（SFB）从114胃切除术标本。采用回归模型分析了淋巴结取出方法、患者特征、肿瘤学因素和手术方式对淋巴结计数的影响。还使用风险调整的累积和图方法分析淋巴结计数。淋巴结计数在研究过程中增加（P < 0.005）。病理学家和淋巴结提取方法是淋巴结计数的独立预测因素。MND的淋巴结计数低于SFB（58比66，P < 0.05）。病理医师对MND的影响（R-2：0.297-0.518，P < 0.0001），而对SFB的影响不明显（R-2：0.340-0.344，P > 0.05）。5 mm以下的阳性淋巴结的百分比分别为24.2%和44.1%的MND和SFB，导致癌症的upstaging（P = 0.037）。结论：系统性脂肪阻断与较高的总淋巴结和阳性淋巴结产量相比，MND和是独立的病理学家。忽略小淋巴结可能是遗漏阳性淋巴结的主要原因，进而导致癌症分期下降。
Aims: To examine factors that influence lymph node count and to study the relationship between nodal size and metastatic involvement in gastric cancer.Methods and results: Observational study comparing lymph node retrieval by manual nodal dissection (MND) and systematic fat blocking (SFB) from 114 gastrectomy specimens. The influence of lymph node retrieval method, patient characteristics, oncological factors and surgical approach on lymph node count were examined using regression models. The risk-adjusted cumulative sum chart method was also used to analyse lymph node count. The lymph node count increased during the course of this study (P < 0.005). Both pathologist and lymph node retrieval method were independent predictors for lymph node count. MND yielded lower lymph node counts than SFB (58 versus 66, P < 0.05). The pathologist influenced lymph node retrieval by MND (R-2: 0.297-0.518, P < 0.0001), but not SFB (R-2: 0.340-0.344, P > 0.05). The percentage of positive lymph nodes below 5 mm was 24.2% and 44.1% for MND and SFB, respectively, resulting in cancer upstaging (P = 0.037).Conclusions: Systematic fat blocking is associated with a higher total and positive lymph node yield compared to MND and is independent of the pathologist. Ignoring small lymph nodes can be a major cause for missing positive nodes, leading in turn to cancer down-staging.