| Gastric cancer is the most common malignant tumor all over the world, especially in China. Its incidence,which in the second place, is only lower than lung cancer. The death rate continued to hold a variety of malignant tumors of the first current. Lymph node metastasis is the most important transfer channels. Lymph node dissection of gastric cancer surgery is always the most contentious issues. Both Eastern and Western scholars have their own point of view in this aspect. So far they have not reached consensus.Japan and other East Asian countries believed that if the patients with gastric cancer did the extensive lymph node dissection, it could increase the 5-year survival rate . Besides,the incidence of complications and mortality did not increase. They adopted a multi-center retrospective study of a large sample which showed the significance of lymph node dissection in gastric cancer surgery. Japan formulated the statute of gastric cancer treatment in 1960s. 13 versions have been revised. 14th version is also forthcoming. Statute of cancer treatment grouped gastric lymph node mainly based on tumor location, depth of invasion and lymph node metastasis. It also developed the scope of the rationalization of lymph node dissection. Study shows that lymph node dissection for gastric cancer patients increase 5-year survival rate significantly which did not increase the operative complications and mortality.We believe that the clinical and pathological staging developed by Japan, which is based primarily on lymph node metastasis of gastric cancer, is constantly updated, scientific and rational; the advocated and popular standard lymph node dissection is fine, so the bulk of the gastric cancer treatment significantly improved, and thus is widely recognized. In view of the advantages of D2 radical resection in radical cure and prognosis, it has become the standard of gastric cancer. It played an important role in gastric cancer surgery. Although we agree to the Japanese gastric cancer statute dealing with lymph node dissection, because of the different timing of visits, most of gastric cancer patients are diagnosed as advanced cancer. Therefore, lymph node dissection is not exactly the same as Japan because of the differences of lymph node metastasis and Japanese data.According to the Statute of 13th edition of gastric cancer lymph node groupings, Section 14 shows that the superior mesenteric vessel lymph nodes, can be divided into superior mesenteric artery (14a) and the superior mesenteric vein (14v) 2 subgroups. 14v lymph nodes in gastric cancer are the second group lymph nodes. According to 13th edition principles of gastric cancer lymph node dissection in the Statute, 14v lymph nodes should be cleaned regularly in the D2 radical resection. In the forthcoming issue of the 14th Edition "Statute of cancer treatment", the 14v group will be classified as M1, needn't to clean in D2 surgery. But after that, there is a higher long-term survival rate after cleaning 14v lymph node metastasis. So the clinical significance of the 14v group lymph node dissection cannot be denied. Further study is required to analyze and do research on its metastasis and prognosis in further.This paper reviews 86 gastric cancer patients who were treated by radical lymph node dissection (D2 radical resection of gastric cancer) in our hospital from January 2009 to February 2010. With clinical data retrospectively analyzing, we discussed 14v lymph node metastasis of patients with gastric cancer in order to provide evidence for the scope of rational choice in lymph node dissection.Objective: Through investigating 14v lymph node metastasis of patients withâ…¢A,â…¢B,â…£gastric antrum cancer, we try to analyze regular pattern of 14v lymph node metastasis and provide evidence for the scope of rational choice in lymph node dissection.Methods: Prospective studying of 86 casesâ…¢A,â…¢B,â…£of gastric cancer underwent radical distal gastrectomy patients, we try to find out the regular pattern of 14v lymph node metastasis.Results: In these 86 cases, 3 patients had 14v lymph node metastasis, lymph node metastasis rate is 3.49%. Distribution of 14v lymph nodes of the 86 cases, 3 cases have metastasis; 7 cases were detected lymph node; 5 have metastases; 10 cases were found to be adipose tissue.Three cases with 14v lymph node metastasis had invaded through the serosa. One case in gastric antral had violated transverse mesocolon. 2 cases in the greater curvature of gastric antrum violate pylorus, involving the duodenum. According to the Japanese Gastric Cancer Treatment 13th edition of the staging statute of gastric cancer principles, in 86 cases, 29 casesâ…¢A, 20 casesâ…¢B, 37 casesâ…£. The percentage were: 33.72%, 23.26% , 43.02%. 3 cases had 14v lymph node metastasis, in which 2 cases were stageâ…£cancer, 1 case wasâ…¢B tumor.Three cases occurred 6 groups lymph node metastasis, 1 case was found transverse mesocolon lymph node metastasis while surgical exploration. 3 patients recovered well and through telephone follow-up, two cases of survival of 10 months, 1 lost.Conclusions:(1) Lymph node metastasis rate and the detection rate of 14v Group lymph node in advanced gastric antrum cancer were low. If metastasis happened, the tumors are commonly in the antral greater curvature and mostly for the late stage of tumor.(2) When 14v lymph node metastasis, 6 groups lymph nodes metastasis were more likely to occur metastasis because of its close connection with 14v lymph node. 6 group lymph node metastasis will be found when the 14v group metastasis existing. But 13 group, 15 group have no clear relationship with 14v.(3)The cases with 14v lymph node metastasis that underwent lymph node dissection get good prognosis. However, because of small number cases and short follow-up time, further research should be taken to draw more precise conclusions. |
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