[IGCC2015]腹主动脉旁淋巴结清扫术适应证——Mitsuru Sasako教授访谈-肿瘤瞭望

[IGCC2015]腹主动脉旁淋巴结清扫术适应证——Mitsuru Sasako教授访谈

作者: M.Sasako 日期:2015/6/6 20:33:51 浏览量:22867

编者按：第11届国际胃癌大会上，来自日本兵库医科大学的Mitsuru Sasako教授在“Lymph node dissection” 专场做了题为“Indication of para-aortic nodal dissection”的学术报告。报告中，Sasako教授介绍了JCOG 9501研究的相关内容，该研究比较了临床MO期进展期胃癌的标准D2手术与D2+腹主动脉旁淋巴结清扫术，还介绍了腹主动脉旁淋巴结的转移的有关内容。随后，《肿瘤瞭望》对Sasako教授进行了现场采访。

Oncology Frontier: Since the para-aortic nodal dissection is very complicated， there are safety concerns. Do you have any helpful tips for the dissection of the para-aortic lymph node?   　　《肿瘤瞭望》：腹主动脉旁淋巴结的清扫难度很大，其安全性也是我们非常关注的。那么您在清扫该站淋巴结的时候，有没有什么特别的注意要点或技巧呢？   　　Dr Sasako: It is not necessary for every surgeon to perform para-aortic node dissection. Patients who are candidates for para-aortic node dissection should be centralized to a special hospital where they have very good surgeons and high volume and also very good medical oncologists. In our country， for instance， not many surgeons can do this procedure. I think it is very important for us to transmit this technique to the younger generation of surgeons but not everybody， just limited numbers of specialist surgeons who have very good technique in D2 surgery. If surgeons do not have good technique for D2 surgery， they should not do para-aortic node dissection.   　　Dr Sasako: 并不是每个外科医生都需要掌握腹主动脉旁淋巴结切除的操作。那些需要进行腹主动脉旁淋巴结切除的患者需要去寻求技术较好的外科医生的帮助，到有很多病例获得较好肿瘤学疗效的专科医院就诊。比如说在日本，并没有很多外科医生掌握这项技术操作。我认为重要的是将这门技术传授给年轻的外科医生而不是每一个医生。这样可以限制具备D2淋巴结清扫的专科外科医生的数量。如果外科医生不具备较好的D2淋巴结清扫的技能，那么他们就不能对患者实施腹主动脉旁淋巴结切除。   　　Oncology Frontier:  Could you summarize the metastatic patterns of para-aortic lymph node， and its relationship with TMN stage and surrounding lymph nodes?   　　《肿瘤瞭望》：可否总结一下，腹主动脉旁淋巴结的转移规律？其转移与胃癌的TMN分期、周围淋巴结的关系是什么？   　　Dr Sasako: About 20-30% of patients have para-aortic node metastases and the survival rate for these patients is small. That is why we conducted clinical studies for prophylactic para-aortic node dissection. But it is not essential surgery and only limited numbers of patients will benefit from para-aortic lymph node dissection. From the clinical study data， the most related lymph node station is number 7. If a patient has number 7 nodal metastasis (the lymph node along the left gastric artery)， there is a high incidence of metastasis to the para-aortic area. If the patient has para-aortic node metastasis， we don’t apply any TNM other than stage IV.   　　Dr Sasako:  大概有20-30%的患者会有腹主动脉旁淋巴结转移，而他们的存活率相对较低，因此我们要进行腹主动脉旁淋巴结切除的研究的原因。但是这也不是必须的外科手术操作，而且能够从腹主动脉旁淋巴结切除中获益的患者有限。从现有的临床数据可以得出的结论就是，与腹主动脉旁淋巴结转移最相关的淋巴结就是第7组淋巴结。如果一个患者发现第7组淋巴结（沿着胃左动脉走行的淋巴结）发生转移，那么他就有很大的几率发生腹主动脉旁淋巴结转移。如果一个患者出现了腹主动脉旁淋巴结转移，那么他的肿瘤分期就直接达到了IV期。   　　Oncology Frontier: As we know， para-aortic lymph node metastasis is highly relevant to the serosal invasion and depth of invasion.  Would patients with T1-T3 stage benefit from para-aortic nodal dissection?   　　《肿瘤瞭望》：众所周知，腹主动脉旁淋巴结的转移与肿瘤部位的浆膜侵袭、浸润深度高度相关。那么对于T1-T3分期的患者，术中行腹主动脉旁淋巴结是否也能获益呢？   　　Dr Sasako:  The candidates for para-aortic node dissection are those with clinically diagnosed para-aortic metastases limited to certain areas (around the 16a2 to b1 area) and those who have bulky lymph node metastases surrounding select hepatic and splenic arteries with or without clinically diagnosed para-aortic node metastasis. This is a definite indication at the moment. For the potential candidate for para-aortic node dissection limited to the 16a2 lateral area (left lateral to the aorta above the left renal vein)， that area can be dissected easily and should be dissected for advanced gastroesophageal junctional tumors.   　　Dr Sasako: 适合做腹主动脉旁淋巴结切除的患者主要包括那些临床上确诊为特定区域（淋巴结16a2或者b1）的腹主动脉旁淋巴结转移，还有那些在肝动脉、脾动脉出现淋巴结转移的患者，不论他有没有腹主动脉旁淋巴结转移。现在就可以得到一个比较明确的指示。对于那些局限于淋巴结16a2区域（在左侧肾静脉的上方动脉的左侧方）的腹主动脉旁淋巴结切除的胃食管结合部肿瘤患者，这个区域应该被切除而且也相对较容易被切除。

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