The principle of gastric cancer surgery lymph node cleaning

Gastric cancer is the third largest cause of death in the world, and surgery is still the only hope for gastric cancer root treatment. Gastric resection includes lymph node scan combination combined with sophomoline chemotherapy is the cornerstone of gastric cancer multi -mode treatment. Compared with Japan and South Korea, which has a high degree of standardization of early diagnosis and early screening, the early diagnosis rate of gastric cancer in my country is low, and the 5 -year survival rate of gastric cancer patients is still very unsatisfactory. In addition to actively promoting the people to actively prevent, early diagnosis and early treatment, the improvement of the quality of gastric cancer surgery has become one of the most important strategies to improve the 5 -year survival rate of gastric cancer in my country. Full and appropriate lymph node cleaning is the core content of surgical quality control. This article introduces the popularity of gastric cancer lymph nodes of gastric cancer during different diseases.

First, for the period of local progress (non -early gastric cancer)

-Lymph nodes (LN) transfer is an independent factor for poor prognosis. The more lymph nodes are transferred, the worse the prognosis is. Lymph node cleansing is an effective strategy that surgeons can win. The number of lymph nodes is not enough. It is also a bad factor for prognosis. At least 15 to 20 lymph nodes are the lowest standard for gastric cancer root treatment.

-The expanding lymph node cleansing cannot further improve the survival results of gastric cancer surgery. Studies have shown that the expansion to the third stop does not change the treatment effect of gastric cancer during local progress.

-The combined spleen removal for lymphatic cleaning may cause the prognosis. Because 10 groups of lymph nodes grow at the spleen door with dense spleen vascular vessels. For a period of time, the spleen resection of the gastric cancer routinely developed the spleen. But later clinical studies proved that the combined spleen resection did not bring benefits to patients. Unless there is a clear spleen door lymph node metastasis, spleen removal is generally avoided at present.

Second, for advanced gastric cancer

Once the gastric cancer is metastasis, it is difficult to further improve the efficacy even if multi -organ resection includes a joint transfer site. Excessive scope surgery complications have more complications, which leads to the difficulty of recovery after surgery, and even knows that the prognosis is worse.

However, the lymph node fusion swelling occurs in non -local lymph nodes. For example, the abdominal aorta A2 group, when surgery is highly suspected of existing lymph node metastasis, and excluding distant metastases such as peritoneal metastasis or liver metastases, accurate lymph nodes expanded expansion Cleaning may still bring benefits to such high choices.

Third, for early stomach cancer

Early gastric cancer is defined as a superficial gastric cancer that does not exceed the lower level of the mucosa. This type of gastric cancer is rarely metastasized because of early discovery. Therefore, the Japanese Gastrointestinal Cancer Association (JGCA) recommends that the D1 lymph node cleaning, or the D1+Alpha/Beta cleaning. , Without having to make a big sweep along the blood vessels.

After all, lymph nodes have its physiological function, and unnecessary expansion of surgery to remove many "innocent" normal lymph nodes will inevitably cause adverse effects on the quality of life. According to the position and depth of gastric cancer, the pathological type, and even the type of molecular type, how to properly perform individualized lymphatic cleaning, it is still important propositions that have attracted much attention in the field of gastric cancer in the current and future time. Some scholars have built mathematical models according to the occurrence of gastric cancer in different parts, and have certain application value clinically.

Summarize

In addition to the comprehensive gastric resection during the progressive gastric cancer surgery, the cleaning of lymph nodes needs to reach the second stop, that is, D2 lymph nodes, which is recognized as a standard surgical method for gastric cancer. For advanced gastric cancer, it is usually not recommended for direct surgical treatment. Consider active transformation first. After the condition is relieved, surgical treatment is considered. Early gastric cancer According to the infiltration depth, pathological type, and disease parts, the individualized choice is sufficient and non -excessive lymph nodes, that is, the individual lymph nodes clear.

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