Routine modified D2 lymphadenectomy performance in pT1-T2N0 gastric cancer  

作　　者：John Griniatsos Hara Gakiopoulou Eugenia Yiannakopoulou Nikoletta Dimitriou Gerasimos Douridas Afrodite Nonni Theodoros Liakakos Evangelos Felekouras 

机构地区：[1]1st Department of Surgery,University of Athens,Medical School, LAIKO Hospital,GR 115-27,Athens,Greece [2]Department of Pathology, University of Athens,Medical School,LAIKO Hospital,GR 115-27,Athens,Greece [3]3rd Department of Surgery,University of Athens,Medical School,ATTIKO Hospital,GR 115-27,Athens, Greece

出　　处：《World Journal of Gastroenterology》2009年第44期5568-5572,共5页世界胃肠病学杂志（英文版）

摘　　要：AIM： To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemicaUy detected skip micrometastases in level 11 lymph nodes. METHODS： Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0. All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the level Ⅰ lymph node stations （n = 4） were excluded from further analysis. The level 11 lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS： Skip micrometastases in the level Ⅱ lymph nodes were detected in 14% （4 out of 28） of the patients. The incidence was further increased to 17% （4 out of 24） in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No. 7 lymph node station. Thus, the disease was upstaged from stage Ⅰ A to Ⅰ B in one patient and from stage Ⅰ B to Ⅱ in three patients. CONCLUSION： In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2＋/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.AIM:To evaluate routine modified D2 lymphadenectomy in gastric cancer,based on immunohistochemically detected skip micrometastases in levelⅡlymph nodes. METHODS:Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy,from January 2004 to December 2008,32 were classified as pN0.All levelⅠlymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the levelⅠlymph node stations(n=4)were excluded from further analysis.The levelⅡlymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS:Skip micrometastases in the levelⅡlymph nodes were detected in 14%(4 out of 28)of the patients. The incidence was further increased to 17%(4 out of24)in the subgroup of T1-2 gastric cancer patients.All micrometastases were detected in the No.7 lymph node station.Thus,the disease was upstaged from stageⅠA toⅠB in one patient and from stageⅠB toⅡin three patients. CONCLUSION:In gastric cancer,true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.

关 键 词：Gastric cancer D2 gastrectomy D2 lymphadenectomy MICROMETASTASES Skip metastases Skip micrometastases 

分 类 号：R735.2[医药卫生—肿瘤]