背景:在胃癌切除术期间,背台解剖(BTD)包括基于LN站从手术标本中检查和分离淋巴结(LN)包,作为单独标记的标本被送到病理学。对临床结果有潜在影响,我们的目的是探讨BTD如何影响检查的LN数量。
方法:对胃癌数据库进行了回顾性回顾,包括2009年1月至2022年3月进行的胃癌D2淋巴结清扫术的所有病例。使用Mann-WhitneyU和Fisher精确检验比较背表解剖和常规组。使用多元线性回归模型来确定所检查的LN数量的潜在预测因子。
结果:总共174例患者被确定为:39例(22%)BTD和135例(78%)常规患者。BTD组中更多的患者接受了新辅助化疗(62%vs29%,P<0.05)。与常规组相比,BTD组检查了更多的LN(42[26-59]vs21[15-33],中位数[IQR],P<.001),较低的LN阳性率(0.01vs.07,P=.013),BMI>35的患者的LN数量更多(32.5[27.5-39]vs22[13-27],P=.041)。控制年龄的多元线性回归模型,BMI,术前N期,新辅助化疗,外科医生的经验,和手术方法确定BTD为LN检查数量的显著正预测因子(β=19.7,P=.001)。
结论:回表解剖可提高胃癌切除术中的LN产量。作为一个简单的技术补充,BTD有助于增强病理检查并提高外科医生的意识,这可能最终转化为改善肿瘤的结果。
BACKGROUND: During gastric cancer resection, back table dissection (BTD) involves examination and separation of lymph node (LN) packets from the surgical specimen based on LN stations, which are sent to pathology as separately labeled specimens. With potential impact on clinical outcomes, we aimed to explore how BTD affects number of LNs examined.
METHODS: A retrospective review of a gastric cancer database was performed, including all cases of gastrectomy with D2 lymphadenectomy from January 2009 to March 2022. Back table dissection and conventional groups were compared using Mann-Whitney U and Fisher\'s exact tests. Multiple linear regression modeling was used to identify potential predictors of number of LN examined.
RESULTS: A total of 174 patients were identified: 39 (22%) BTD and 135 (78%) conventional. More patients in the BTD group underwent neoadjuvant chemotherapy (62% vs 29%, P < .05). Compared to the conventional group, the BTD group had a greater number of LNs examined (42 [26-59] vs 21[15-33], median [IQR], P < .001), lower LN positivity ratio (.01 vs .07, P = .013), and greater number of LNs in patients with BMI >35 (32.5[27.5-39] vs 22[13-27], P = .041). A multiple linear regression model controlling for age, BMI, preoperative N stage, neoadjuvant chemotherapy, surgeon experience, and operative approach identified BTD as a significant positive predictor of number of LN examined (β = 19.7, P = .001).
CONCLUSIONS: Back table dissection resulted in improved LN yield during gastric cancer resection. As a simple technical addition, BTD helps enhance pathology examination and improve surgeon awareness, which may ultimately translate to improve oncologic outcomes.