Effects of novel path of lymph node dissection combined with peripheral vascular occlusion for the treatment of gastric cancer in stage ⅢC / 中华消化外科杂志

ABSTRACT

Objective To investigate the clinical efficacy of a novel path of lymph node dissection combined with peripheral vascular occlusion for the treatment of gastric cancer in stage ⅢC.Methods The clinical data of 142 patients with gastric cancer in stage Ⅲ C who were admitted to the 175th Hospital of PLA from January 2006 to December 2009 were retrospectively analyzed.Seventy patients received novel path of lymph node dissection combined with peripheral vascular occlusion (combined group) and 72 patients received simple lymph node dissection via the novel path (simple group).The positive rate of mRNA expression of carcinoembryonic antigen (CEA) and the distal metastatic rate of tumor cells between the 2 groups were compared.Patients were followed up via outpatient examination,phone call and in-patient examination till January 2013.The measurement data and the enumeration data were analyzed using the t test and the chi-square test,respectively.Results The operation time,volume of blood loss and number of lymph nodes dissected were (184 ± 26) minutes,(282 ± 80) mL and 28 ± 5 in the combined group,(180 ± 28)minutes,(355 ± 85)mL and 27 ± 5 in the simple group,with no significant difference between the 2 groups (t =0.882,5.267,0.496,P ＞ 0.05).The positive rates of mRNA expression of CEA of the combined group and the simple group were 10.0％ (7/70) and 9.7％ (7/72),with no significant difference between the 2 groups (x2 =0.003,P ＞ 0.05).The positive rates of mRNA expression of CEA after lymph node dissection of the combined group and the simple group were 2.9％ (2/70) and 16.7％ (12/72),with significant difference between the 2 groups (x2 =8.240,P ＜ 0.05).The positive rates of mRNA expression of CEA after total gastrectomy of the combined group and the simple group were 4.3％ (3/70) and 4.2％ (3/72),with no significant difference between the 2 groups (x2=0.001,P ＞ 0.05).All patients were followed up at postoperative year 1,and 139 patients were followed up at postoperative year 3.The median time of follow-up was 33.5 month (range,12.0-42.0 month).The 1-year distal metastatic rate of the combined group and the simple group were 7.1％ (5/70) and 8.3％ (6/72),with no significant difference between the 2 groups (x2=0.070,P ＞0.05).The 3-year distal metastatic rate of the combined group and the simple group were 33.3％ (23/69) and 51.4％ (36/70),with significant difference between the 2 groups (x2=4.660,P ＜0.05).The distal metastatic rates of distal parenchymatous organs of the combined group and the simple group were 10.1％ (7/69) and 44.3％ (31/70),with significant difference between the 2 groups (x2=20.390,P ＜ 0.05).Conclusions Novel path of lymph node dissection combined with peripheral vascular occlusion can block the lymph node and blood backflow,and thus effectively reduces the distal metastatic rate of gastric cancer in stage ⅢC after operation.