| Research background and Objective:Gastric cancer?GC?is one of the most frequently occurring malignancics.According to the GLOBOCAN2012statistics released[1],there were about 951000 new cases of gastric cancer in2012,ranking the 5th malignant tumors in the world,of which about half of the cases occurred in East Asia,and China was the main disease area;the number of deaths is about 723000,ranking the 3th cause of death due to cancer.The current comprehensive treatment of gastric cancer is based on surgery.Lymph node metastasis is often used as an important indicator to evaluate the prognosis of patients with gastric cancer[2].The 4th edition of the Japanese gastric cancer guidelines treatment point out[3]:the curative surgery of standard gastrectomy should involves the dissection of D2 lymph node,which is widely accepted at present.In recent years,the study has found that[4],the lymph node metastasis rate of splenic hilum is about 9%to 27.9%,which hints the importance of the dissection of splenic hilar lymph node that as the second station of lymph node in the middle and/or upper gastric carcinoma.But the position of spleen is deep and the texture is crisp,at the same time,the relationship between the splenic artery and pancreatic tail is complicated that including the anatomical variation.And as the influence of the space of operation and the blood vessel,the lymphatic vessel,the adipose connective tissue,which easily lead to the injury of blood vessel and spleen in the process of dissection,even causes severe complications such as hemorrhage that is difficult to control or splenic infarction.In addition,as it is not recommended to perform a prophylactic splenectomy for dissect the splenic hilar lymph node at present,and it is difficult to be dissected of spleen-preserveing.Therefore,the domestic and foreign scholars have begun to study the risk factors of splenic hilar lymph node metastasis and the necessity of dissection,which strive to minimize the surgical trauma and complications and make patients attain benefits in long-term survival[5],[6].According to reports in the literature[7],the splenic hilum lymph node metastasis is related to the tumor size,tumor location,depth of invasion and the lymph node metastasis of No.4sb.It is suggested that lymph node dissection at splenic hilum should be performed on the basis of its rule of metastasis of higher risk.There scholars have found that the tumor transverse location,Borrmann type,T stage and TNM stage are the high risk factors of splenic hilum lymph node metastasis in 82 cases who underwent radical gastrectomy.Then they suggested that it is should be perform the dissection of the splenic hilar lymph node routinely in the middle and/or upper gastric cancer when the tumor is located in the greater curvature,or the pathological characteristics is Borrmann type??,stage T3 or T4,stage?or?[8].Zhu et al[4]have found that stage pT,stage p N and the distant lymph node metastasis are the independent risk factors of splenic hilar lymph node metastasis.But there is no significant difference in survival time between R0 resection group and R1-R2 resection group for patients with splenic hilar lymph node metastasis.They have considered it is an incurable factor,which lead to further explore the necessity of splenic hilar lymph node dissection.In a word,there is no definite conclusion about metastasis and dissection of splenic hilum lymph node at present.I have found that the study of the risk factors of splenic hilum lymph node are usually judged by clinical metastasis through search the related literature in recent years.However,there is a tendency to develop into clinical metastasis by the splenic hilar lymph node micrometastasis.If this potential possibility is ignored,the long-term survival of patients may be affected.Therefore,we use the micrometastasis as the criterion,the risk factors of splenic hilum lymph node metastasis are analyzed,and the indications of its dissection are explored.Methods:Collecting the clinicopathological data of 76 patients with middle and/or upper gastric cancer,who underwent the standard D2 radical surgery and splenic hilar lymph node dissection in the gastrointestinal surgery of southwest medical university affiliated hospital from June 2013 to January 2018.The splenic hilar lymph nodes of 76 cases were examined by routine pathological methods,screening out the negative cases,detecting the micrometastases by the mouse anti-human cytokerat monoclonal antibody?CK19,CK20?in splenic hilar lymph nodes through the SP method of immunohistochemical.The presence of metastasis or micrometastasis of splenic hilar lymph node would be included in the group of splenic hilar lymph node metastasis,whereas would be in the negative group.Analyzing the related risk factors of splenic hilar lymph node metastasis,and then to discuss the surgical indications of its dissection.Results:1.The results of univariate analysis show that the splenic hilar lymph node metastasis is related to the location of tumor?including transverse and longitudinal sites?,Borrmann type,depth of invasion,lymph node metastasis,the lymph node metastasis of No.2 or No.4sb and TNM stage?P<0.05?.However,there is no significant difference between splenic hilar lymph node metastasis and the age,gender,tumor size,differentiation degree,vascular invasion,nerve invasion,the lymph node metastasis status of No.1,No.3,No.4sa,No.7,No.11?P>0.05?.2.The results of Logistic regression analysis show that the longitudinal location of tumor,depth of invasion and the metastasis of No.4sb lymph node are the independent risk factors of splenic hilar lymph node metastasis?P<0.05?.The risk of splenic lymph node metastasis will raise when the tumor is located in the gastric fundus or cardia,invades the serosa and the positive metastasis of No.4sb lymph node.Conclusion:1.The longitudinal location of tumor,depth of invasion and the metastasis of No.4sb lymph node are the independent risk factors of splenic hilar lymph node metastasis2.It is suggested that the splenic hilar lymph node dissection should be performed routinely in the upper and/or middle gastric cancer,when the tumor is located in the gastric fundus or cardia,invades the serosa and the positive metastasis of No.4sb lymph node.?one of the conditions above should be satisfied?... |
PDF Full Text Request