An Analysis Of The N₀ 12 Lymph Node Dissection For 70 Patients With Advanced Gastric Carcinoma

Objective To study the necessity and feasibility of No12 LN dissection for advanced gastric carcinoma. Method The clinical data of 135 patients who were diagnosed as advanced gastric carcinoma were collected between March 2004 and March 2006 in Gastrointestinal Surgery Center of Union Hospital . 70 cases of them received D2 or selective D3 operation , all of which were plus No12 LN dissection,as No12 LN dissection team . The relationship between No12 LN metastasis and clinicopathologic factors was analyzed. As non- No12 LN dissection team ,the rest 65 cases with advanced gastric carcinoma received D2 or selective D3 operation ,but none of which were plus No12 LN dissection .At last ,the average hospital stay days after operation ,operation time ,bleeding volume and the incidence of post-operation complication were analyzed . Results In No12 LN dissection team ,a total of 2045 lymph nodes with an average of 29.21 per specimen were removed , 807(39.46%) lymph nodes of which were found metastasis positive. Lymph node metastasis were encountered in 12(17.14%) patients in No12 LN dissection team , including 23.08% in BorrmannⅢ,Ⅳtypes,26.09% in N2-3,30.77% in T3-4,36.36% in tumor mass 4cm -8cm large,57.14% in tumor mass larger than 8cm and 41.38% in tumor mass larger than 4cm . Positive No12 LN metastasis rate found in patients with BorrmannⅢ,Ⅳtypes,N2-3,T3-4,tumor mass 4cm -8cm large,tumor mass larger than 8cm and tumor mass larger than 4cm was statistically significantly higher than that in BorrmannⅠ,Ⅱtypes(0%),N0-1(0%),T1-2 (0%) and tumor mass smaller than 4cm(0%), respectively(P<0.05) ,and the statistically correlation existed between No12 LN metastasis and N03,4,5,6 lymph node metastasis.The tumor located in midbody or occupied more than one-third area of the stomach ,the incidence of No12 LN metastasis of which increased and the tumor belonged to histotypes such as mucinous adenocarcinoma,poorly differentiated adenocarcinoma,tubular adenocarcinoma, the incidence of No12 LN metastasis of which increased also .Secondly , the average hospital stay days after operation of No12 LN dissection team and non- No12 LN dissection team respectively were :( 16.49±3.69)days,(15.45±3.56)days ;bleeding volume respectively were (458.57±160.16)ml,(435.87±170.23)ml; operation time respectively were(5.12±0.75 )hours,(4.79±0.71)hours;no statistically significant difference existed between the two teams (P﹥0.05) except that the operation time of the dissection team was statistically significantly longer than that of the non-dissection team ,and no significant difference was found in the incidence of post-operation complication between the two teams ,7(10%)cases in No12 LN dissection team vs 9(13.85%) cases in non- No12 LN dissection team, P﹥0.05.No significant clinical therapy , operation risk and death attributed to operation were found in 135 cases. Conclusion No12 LN dissection is necessary and feasible for advanced gastric carcinoma. Further prospective studies on the influence of No12 LN dissection on prognosis in more cases are required.