Advanced Distal Gastric Cancer Lymph Node Metastasis Of14V Correlation Analysis

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 lungcancer. The death rate continued to hold a variety of malignant tumors of the firstcurrent. Lymph node metastasis is the most important transfer channels. Lymph nodedissection of gastric cancer surgery is always the most contentious issues. BothEastern and Western scholars have their own point of view in this aspect. So far theyhave not reached consensus.Japan and other East Asian countries believed that if the patients with gastriccancer did the extensive lymph node dissection it could increase the5-year survivalrate. Besides the incidence of complications and mortality did not increase. Theyadopted a multi-center retrospective study of a large sample，which showed thesignificance of lymph node dissection in gastric cancer surgery. Japan formulated thestatute of gastric cancer treatment in1960s.13versions have been revised.14thversion is also forthcoming. Statute of cancer treatment grouped gastric lymph nodemainly based on tumor location， depth of invasion and lymph Node metastasis. Italso developed the scope of the rationalization of lymph node dissection. Study showsthat lymph node dissection for gastric cancer patients increase5-year survival ratesignificantly， which did not increase the operative complications and mortality.We believe that the clinical and pathological staging developed by Japan， which isbased primarily on lymph node metastasis of gastric cancer， is constantly updated，scientific and rational; he advocated and popular standard lymph node dissection isfine， so the bulk of the gastric cancer treatment significantly improved， and thus iswidely recognized. In view of the advantages of D2radical resection in radical cureand prognosis， it has become the standard of gastric cancer. It played an importantrole 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 ofgastric cancer patients are diagnosed as advanced cancer. Therefore， lymph nodedissection is not exactly the same as Japan because of the differences of lymph nodeMetastasis and Japanese data.According to the Statute of13th edition of gastric cancer lymph nodegroupings，Section14shows that the superior mesenteric vessel lymph nodes，can bedivided into superior mesenteric artery (14a) and the superior mesenteric vein (14v)2subgroups.14v lymph nodes in gastric cancer are the second group lymph nodes.According to13th edition principles of gastric cancer lymph node dissection in theStatute，14v lymph nodes should be cleaned regularly in the D2radical resection. Inthe forthcoming issue of the14th Edition "Statute of cancer treatment"， the14vgroup will be classified as M1，needn’t to clean in D2surgery.But after that，there is a higher long-term survival rate after cleaning14v lymph nodemetastasis. So the clinical significance of the14v group lymph node dissection cannotbe denied. Further study is required to analyze and do research on its metastasis andprognosis in further.This paper reviews86gastric cancer patients who were treated by radical lymphnode dissection (D2radical resection of gastric cancer) in our hospital from January2009to February2010. With clinical data retrospectively analyzing， we discussed14v lymph node metastasis of patients with gastric cancer in order to provideevidence for the scope of rational choice in lymph node dissection.Objective: Through investigating14v lymph node metastasis of patients with Ⅲ A，Ⅲ B，Ⅳ gastric antrum cancer，we try to analyze regular pattern of14v lymph nodemetastasis and provide evidence for the scope of rational choice in lymph nodedissection.Methods: Prospective studying of86cases Ⅲ A，Ⅲ B，Ⅳ of gastric cancerunderwent radical distal gastrectomy patients，we try to find out the regular patternof14v lymph node metastasis.Results: In these86cases，3patients had14v lymph node metastasis， lymph node metastasis rate is3.49%. Distribution of14v lymph nodes of the86cases，3caseshave metastasis;7cases were detected lymph node;5have metastases;10cases werefound to be adipose tissue.Three cases with14v lymph node metastasis had invaded through the serosa. Onecase in gastric antral had violated transverse mesocolon.2cases in the greatercurvature of gastric antrum violate pylorus，involving the duodenum. According tothe Japanese Gastric Cancer Treatment13th edition of the staging statute of gastriccancer principles，in86cases，29cases Ⅲ A，20cases Ⅲ B，37cases Ⅳ. Thepercentage were:33.72%，23.26%，43.02%.3cases had14v lymph nodemetastasis，in which2cases were stage Ⅳ cancer，1case was Ⅲ B tumor.Three cases occurred6groups lymph node metastasis，1case was foundtransverse mesocolon lymph node metastasis while surgical exploration.3patientsrecovered well and through telephone follow-up， two cases of survival of10months，1lost.Conclusions:(1) Lymph node metastasis rate and the detection rate of14v Group lymph node inadvanced gastric antrum cancer were low. If metastasis happened， the tumors arecommonly in the antral greater curvature and mostly for the late stage of tumor.(2) When14v lymph node metastasis，6groups lymph nodes metastasis were morelikely to occur metastasis because of its close connection with14v lymph node.6group lymph node metastasis will be found when the14v group metastasis existing.But13group15group have no clear relationship with14v.(3)The cases with14v lymph node metastasis that underwent lymph nodedissection get good prognosis. However， because of small number cases and shortfollow-up time， further research should be taken to draw more precise conclusions.