Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis
Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis
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DOI：
10.1016/s0039-6060(99)70258-8
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发表时间：
1999-02-01
期刊：
影响因子：
3.8
通讯作者：
Kaibara, N
中科院分区：
文献类型：
--
作者：
Tsujitani, S;Oka, S;Kaibara, N
背景。微创治疗是当前许多外科领域的发展趋势。大多数早期胃癌患者没有淋巴结转移。因此，广泛切除胃和扩大淋巴结清扫似乎是不必要的。在一项回顾性研究中，对890例连续接受标准胃切除术的早期胃癌患者进行了侵袭深度、大体外观和肿瘤最大直径的评估，以探讨限制淋巴结清扫范围的可能性。各种有限胃切除术已经发展起来，目前包括内镜粘膜切除术、楔形切除术、节段性胃切除术、有限近端胃切除术和远端半胃切除术。一项回顾性研究显示，广泛淋巴结清扫并不能提高早期胃癌患者的生存率，内镜下粘膜切除术适用于直径小于1cm的凹陷型和直径小于2cm的升高型肿瘤。楔形、节段或有限近端胃切除术适合直径2至3cm的隆起型胃切除术。直径大于3cm的升高型和直径大于3cm的降低型有时会转移到第1组淋巴结。直径大于3cm的凹陷型有时会转移到2组淋巴结。因此，这类病例应行胃切除术并切除潜在的转移淋巴结。根据肿瘤的大体外观和大小，可以限制胃切除术和淋巴结清扫的范围。
Background. Less invasive treatment is the current trend in many surgical fields. Most patients with early gastric cancer do not have lymph node metastasis. Thus extensive resection of the stomach and extended lymph node dissection do not appear to be necessary.Methods. In a retrospective study, 890 consecutive patients with early gastric cancer who had undergone standard gastrectomy were assessed for depth of invasion, gross appearance and maximum diameter of the tumor to examine the possibility of limiting the extent of lymph node dissection. A variety of limited gastrectomies have bent developed and now include endoscopic mucosal resection, wedge resection, segmental gastrectomy, limited proximal gastrectomy, and distal hemigastrectomy.Results. A retrospective study revealed that extensive lymph node dissection did not improve the survival of patients with early gastric cancer Endoscopic mucosal resection was suitable for cancers of the depressed type of less than 1 cm in diameter and the elevated type of less than 2 cm in diameter. Wedge, segmental, or limited proximal gastrectomy teas suitable for the Elevated type of 2 to 3 cm in diameter. The elevated type of more than 3 cm in diameter and the depressed type of more than 3 cm in diameter sometimes involved metastasis to group 1 nodes. The depressed type of more than 3 cm in diameter sometimes involved metastasis to group 2 nodes. Thus such cases shot tld be treated by gastrectomy with dissection of potentially, metastatic lymph nodes.Conclusion. Limitation of the extent of gastrectomy and lymph node dissection may be possible, depending on the gross appearance and size of the tumor.