文章：

局部晚期/寡转移性胃癌新辅助/转化治疗后后腹膜及主动脉旁（D2plus）淋巴结清扫术

Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer

原文发布日期：31 March 2024

DOI: 10.3390/cancers16071376

类型: Article

开放获取: 是

英文摘要：

Super-extended (D2plus) lymphadenectomy after chemotherapy has been reported in only a few studies. This retrospective study evaluates survival outcomes in a Western cohort of locally advanced or oligometastatic gastric cancer patients who underwent D2plus lymphadenectomy after neoadjuvant chemotherapy. A total of 97 patients treated between 2010 and 2022 were included. Of these, 62 had clinical stage II/III disease, and 35 had stage IV disease. Most patients (65%) received preoperative DOC/FLOT chemotherapy. The mean number of lymph nodes harvested was 39. Pathological positive nodes in the posterior/para-aortic stations occurred in 17 (17.5%) patients. Lymphovascular invasion, ypN stage, clinical stage, and perineural invasion were predictive factors for positive posterior/para-aortic nodes. Postoperative complications occurred in 21 patients, whereas severe complications (grade III or more) occurred in 9 cases (9.3%). Mortality rate was 1%. Median overall survival (OS) was 59 months (95% CI: 13–106), with a five-year survival rate of 49 ± 6%; the five-year OS after R0 surgery was 60 ± 7%. In patients with positive posterior/para-aortic nodes, the median OS was 15 months (95% CI: 13–18). D2plus lymphadenectomy after chemotherapy for locally advanced or oligometastatic gastric cancer is feasible and associated with low morbidity/mortality rates. The incidence of pathological metastases in posterior/para-aortic nodes is not negligible even after systemic chemotherapy, with poor long-term survival.

摘要翻译： 

目前仅有少数研究报道了化疗后实施超扩大（D2plus）淋巴结清扫术。本回顾性研究评估了西方人群中局部进展期或寡转移性胃癌患者在新辅助化疗后接受D2plus淋巴结清扫术的生存结局。研究共纳入2010年至2022年间接受治疗的97例患者，其中62例为临床II/III期疾病，35例为IV期疾病。多数患者（65%）术前接受了DOC/FLOT方案化疗。平均淋巴结清扫数目为39枚。17例（17.5%）患者在后腹膜/主动脉旁淋巴结站发现病理阳性转移。淋巴血管侵犯、新辅助治疗后淋巴结病理分期（ypN分期）、临床分期及神经侵犯是后腹膜/主动脉旁淋巴结阳性的预测因素。术后并发症发生21例，其中严重并发症（III级及以上）9例（9.3%），死亡率为1%。中位总生存期为59个月（95% CI：13-106），五年生存率为49±6%；R0切除术后五年总生存率达60±7%。后腹膜/主动脉旁淋巴结阳性患者的中位总生存期为15个月（95% CI：13-18）。对于局部进展期或寡转移性胃癌患者，化疗后实施D2plus淋巴结清扫术具有可行性，且并发症发生率与死亡率较低。即使经过全身化疗，后腹膜/主动脉旁淋巴结的病理转移发生率仍不容忽视，且患者长期生存预后较差。

原文链接：

Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer