关键词: 晚期胃癌, 腹主动脉旁淋巴结, 淋巴结清扫

Abstract:

Comprehensive treatment strategies of advanced gastric cancer with para-aortic lymph node metastasis        SONG Wu，HE Yu-long. Department of Gastrointestinal Surgery，the First Affiliated Hospital of Sun Yat-sen University，Guangzhou 510080，China
Corresponding author：HE Yu-long，E-mail：YLH@medmail.com.cn
Abstract    The whole treatment process of advanced gastric cancer patients with para-aortic lymph node (PALN) metastasis requires collaborative multidisciplinary treatment (MDT) group to assist the assessment of preoperative staging, decision of treatment plan, selection of operation timing and the control of operation. The parao-aortic nodal dissection (PAND) is an absolute operation indication under the condition that there was no evidence of distant metastasis, the enlargement lymph nodes limited to the No.16a2 and No.16b1 station lymph nodes, and other incurable factors were excluded. Advanced gastric cancer with PALN metastasis adopted comprehensive treatment strategies with chemotherapy and surgery. The effective neoadjuvant chemotherapy was prerequisite, the surgeon’s abundant experience of D2 lymph node dissection and PAND was safety guarantee, the radical dissection of No.16a2 and No.16b1 station lymph nodes may give survival benefit for selected patients. The highly suspected para-aortic lymph node metastasis groups, such as preoperative imaging evaluation for clinical N2 or N3, highly suspected No.9 lymph node metastasis, duodenum invaded, still need to be careful reassessment of preventive PAND value after comprehensive treatment. Under the guidance of preoperative neoadjuvant therapy and MDT discussion, the selected patients may get benefit from therapeutic or prophylactic PAND.

Key words: advanced gastric cancer, para-aortic lymph node, lymph node dissection