CLINICAL SIGNIFICANCE OF SUPRAPYLORIC LYMPH NODE MICROMETASTASIS IN ADAPTATION OF PYLORUS PRESERVING GASTRECTOMY FOR EARLY GASTRIC CANCER

早期胃癌における幽門上リンパ節(以下No.5)への癌微小転移状況から,迷走神経幽門枝/右胃動脈を温存した幽門保存胃切除術(PPG)の適応拡大の可能性について検討した. D2郭清を行った中下部早期胃癌267例を対象にCytokeratin (CAM5.2)染色, HE染色によるNo.5転移状況を検討.癌細胞が1個のtumor cell micro involvement (MI)が6例, cluster形成したmicro metastasis (MM)が2例, HE染色での転移は1例. M癌ではMIが1例. SMI癌では転移を認めず, SM2癌ではMIが5例, MMが2例,HE染色で1例, SM2癌は全体の9.3% (8/86) に転移を認めた.さらにSM2の小彎病変では16.7% (5/30),非小彎病変5.4% (3/56),組織型は全例,中・低分化型で,中低分化型・小彎病変の19.2% (5/26)に転移を認めた.微小転移の臨床的意義はいまだ解明されていないが, SM2癌でのPPG適応の際には慎重を期す必要がある.

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