2004年6月
Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: A critical reappraisal from the viewpoint of lymph node retrieval
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
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- 巻
- 198
- 号
- 6
- 開始ページ
- 933
- 終了ページ
- 938
- 記述言語
- 英語
- 掲載種別
- DOI
- 10.1016/j.jamcollsurg.2004.01.021
- 出版者・発行元
- ELSEVIER SCIENCE INC
BACKGROUND: Laparoscopy-assisted surgery has proved useful in the treatment of early gastric cancer, but its use in advanced cancer may be hindered by limitations in lymphadenectomy.
STUDY DESIGN: Data on lymph node retrieval after distal gastrectomy with D1 or D2 lymphadenectomy (n = 89) performed by the laparoscopy-assisted approach were collected between 1998 and 2002 and compared with data obtained from conventional open surgery performed for T1 cancer at a high-volume hospital (n = 342) during the same period. Comparisons of total number of lymph nodes, retrieval at each lymph node station, and the rate of noncompliance (no nodal tissue documented at a node station that should have been resected) were conducted using Student's t-test and the chi-square test.
RESULTS: D2 resection by the laparoscopy-assisted approach harvested a sufficient number of nodes for adequate TNM classification (> 15 nodes) in 86% of patients. Nevertheless, a significantly greater number of lymph nodes were harvested by open surgery. The difference was significant for the perigastric lymph nodes along the major curvature (Nos. 4 and 6) and second tier nodes along the celiac and splenic arteries (Nos. 9 and 11).
CONCLUSIONS: The extent of lymphadenectomy achieved by current laparoscopic procedure approaches the global standard for accurate staging, although performing extended resection as recommended in Japan remains a challenge. (C) 2004 by the American College of Surgeons.
STUDY DESIGN: Data on lymph node retrieval after distal gastrectomy with D1 or D2 lymphadenectomy (n = 89) performed by the laparoscopy-assisted approach were collected between 1998 and 2002 and compared with data obtained from conventional open surgery performed for T1 cancer at a high-volume hospital (n = 342) during the same period. Comparisons of total number of lymph nodes, retrieval at each lymph node station, and the rate of noncompliance (no nodal tissue documented at a node station that should have been resected) were conducted using Student's t-test and the chi-square test.
RESULTS: D2 resection by the laparoscopy-assisted approach harvested a sufficient number of nodes for adequate TNM classification (> 15 nodes) in 86% of patients. Nevertheless, a significantly greater number of lymph nodes were harvested by open surgery. The difference was significant for the perigastric lymph nodes along the major curvature (Nos. 4 and 6) and second tier nodes along the celiac and splenic arteries (Nos. 9 and 11).
CONCLUSIONS: The extent of lymphadenectomy achieved by current laparoscopic procedure approaches the global standard for accurate staging, although performing extended resection as recommended in Japan remains a challenge. (C) 2004 by the American College of Surgeons.
- リンク情報
- ID情報
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- DOI : 10.1016/j.jamcollsurg.2004.01.021
- ISSN : 1072-7515
- Web of Science ID : WOS:000221844100012