The effect of surgical treatment of gastric cancer cardia is closely related to lymphatic metastasis clearance, and although there is a clear conclusion that lymph node clearance is necessary for gastric cancer, how to use the lymphatic metastasis pattern of this part of the tumor to guide rational surgery still needs to be further improved. We performed radical resection on 97 patients with gastric cancer from October 2006 to October 2009, and the results and clinical data are analyzed as follows.
1. Clinical data
1.1 Excluded cases. (1) Palliative resection such as cases with intra-abdominal implantation, extensive metastasis or fusion of retroperitoneal lymph nodes into a doughnut shape, distant metastasis of extra-abdominal organs and other cases with tumor residue found at the time of surgery. (2) Some cases of early gastric cancer that did not undergo systemic clearance. (3) The number of lymph nodes reported by postoperative pathology was less than 5 despite systematic debulking.
2.Results
2.1 The basis of distribution of lymph node group area in gastric cancer. According to the characteristics of perigastric lymphatic drainage of gastric cancer combined with the experience of surgical systemic clearance, we grouped 16 groups of lymph nodes and treated them as shown in Table 1 below, because in the N10 group, the spleen or combined pancreatic tail was removed only when the tumor involved the short vascular region of the stomach near the splenic hilum or the spleen, and it was relatively difficult to achieve radical treatment in this case, so this group of lymph nodes was not Therefore, this group of lymph nodes was not included in the list.
Table 1 Distribution of lymph node groups in gastric cancer cardia
Lesion site N1 group station area N2 group station area N3 group station area Extra-station area
Upper gastric cancer 1, 2, 3, 4 5, 6, 7, 8, 9, 11 16a,16b1 12,13, 14, 15
Gastric body cancer 1,2,3,4,5,6 7,8,9,11 16a,16b1 12,13,14,15
Lower gastric cancer 3,4,5,6 1,7,8,9,11 16a,16b1 12,13,14,15
2.2 Analysis of lymph node metastasis after gastric cancer pancreatic cancer debulking.
The lymph nodes in the whole group of 97 cases were distributed in the station area of N1 group and the station area of N2 group, and all of them were more than 5 per case, and 33 cases were cleared by 16a,16b1. Among them, 46 cases had R15/case. The average number of lymph nodes cleared was 13/case (5 to 45). the positive distribution of lymph node metastasis after radical surgery for 97 cases of gastric cancer is shown in table 2.
Table 2 Positive distribution of lymph node metastasis after radical surgery for gastric cancer in 97 cases
Lymph node metastasis Lymph node metastasis cases Percentage
N(-) 27 27.8
N(+) 72 72.2
N1 18 18.6
N2 15 15.1
N1 and N2 29 29.9
N3 zone 6(33) 18.2
Out-of-station area 2 2.1
Comparison of lymph node metastasis rate between N1 and N2 areas p