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REGATTA trial - ÀϺ»°ú Çѱ¹ÀÇ ¿Ü°ú ¼±»ý´ÔµéÀÇ °øµ¿¿¬±¸ÀÎ REGATTA trial °á°ú°¡ ¹ßÇ¥µÇ¾ú½À´Ï´Ù (Fujitani K. Lancet Oncology 2016). ¾ç±¹ À§¾Ï°ü·Ã ³»¿Ü°úÀÇ»çµéÀÇ Ã¹ °øµ¿¿¬±¸ÀÔ´Ï´Ù. ÈǸ¢ÇÑ ¼º°ú ÃàÇÏÇÕ´Ï´Ù.

´ÜÀÏ ÀüÀÌ°¡ Àִ ȯÀÚ°¡ ´ë»óÀ̾ú½À´Ï´Ù. "We did an open-label, randomised, phase 3 trial at 44 centres or hospitals in Japan, South Korea, and Singapore. Patients aged 20-75 years with advanced gastric cancer with a single non-curable factor confined to either the liver (H1), peritoneum (P1), or para-aortic lymph nodes (16a1/b2) were randomly assigned (1:1) in each country to chemotherapy alone or gastrectomy followed by chemotherapy."

µî·ÏµÈ ȯÀÚ´Â 175¸íÀ̾úÀ¸³ª Âü¿© ±â°üÀÌ 44°÷À̳ª µÇ¾ú´ø ¿¬±¸ÀÔ´Ï´Ù. ÇÑ ±â°ü¿¡¼­ 4¸í¸¸ µî·ÏµÇ¾úÀ¸´Ï »ó´çÇÑ ¿ì¿©°îÀýÀÌ ÀÖ¾úÀ» °Í °°½À´Ï´Ù. °Ô´Ù°¡ 23¸í (13.1%)Àº Ç×¾ÏÄ¡·áµµ ¹ÞÁö ¸øÇÏ¿´À¾´Ï´Ù. ¿©ÇÏÆ° °á°ú´Â ¸íÈ®Çß½À´Ï´Ù. "Median overall survival was 16¡¤6 months (95% CI 13¡¤7-19¡¤8) for patients assigned to chemotherapy alone and 14¡¤3 months (11¡¤8-16¡¤3) for those assigned to gastrectomy plus chemotherapy (hazard ratio 1¡¤09, 95% CI 0¡¤78-1¡¤52; one-sided p=0¡¤70)."

°á·ÐÀº ´ÙÀ½°ú °°¾Ò½À´Ï´Ù. "Since gastrectomy followed by chemotherapy did not show any survival benefit compared with chemotherapy alone in advanced gastric cancer with a single non-curable factor, gastrectomy cannot be justified for treatment of patients with these tumours." ¾µ¸ð¾ø´Â ¼ö¼úÀº ÇÏÁö ¸»ÀÚ´Â °Í °°½À´Ï´Ù.

±¹³» ¾ð·Ð¿¡ °ü·Ã ±â»ç°¡ ½Ç·È½À´Ï´Ù. [2016-2-26. °æÇâ½Å¹®] ¸»±â À§¾ÏÀÇ À§ÀýÁ¦¼ú »ýÁ¸À² ³ôÀ̱⠾î·Á¿ö


Cancer screening in LT patients

°£ÀÌ½Ä È¯ÀÚ¿¡¼­ ¾Ï°ËÁøÀÇ È¿°ú¿¡ ´ëÇÑ ¾Æ»êº´¿ø ÀÚ·á°¡ ¹ßÇ¥µÇ¾ú½À´Ï´Ù (Jung DH. Transplant Proc 2016 ). Á¤±âÀûÀÎ °ËÁøÀ» ¹ÞÀ¸¸é Á¶±âÁø´ÜÀÌ °¡´ÉÇÏ°í »ýÁ¸À²ÀÌ Çâ»óµÈ´Ù°í ÇÕ´Ï´Ù. ³í¹®¿¡´Â ¾Æ»êº´¿øÀÇ °£ÀÌ½Ä È¯ÀÚÀÇ ¾Ï°ËÁø ÇÁ·ÎÅäÄÝÀÌ ¼Ò°³µÇ¾î ÀÖ¾ú½À´Ï´Ù.

Á¦°¡ Èï¹Ì·Ó°Ô º» °ÍÀº LT ÀüÈÄ À§¾ÏÀÇ ¹ß°ß°ú ÀÓ»ó °æ°ú¿´½À´Ï´Ù. LT ÈÄ °ËÁøÀ» ÅëÇØ ¹ß°ßµÈ À§¾ÏÀÇ Àý¹Ý Á¤µµ¸¦ ³»½Ã°æÀ¸·Î Ä¡·áÇß´Ù´Â Á¡ÀÌ Áß¿äÇÒ °Í °°½À´Ï´Ù.

Àúµµ °£ÀÌ½Ä ÈÄ À§¾ÏȯÀÚ¸¦ ¸î ºÐ Ä¡·áÇÑ °æÇèÀÌ ÀÖ½À´Ï´Ù. ÀÏÀü¿¡ EndoTODAY¿¡¼­ ¼Ò°³ÇÑ ¹Ù Àִµ¥ ¾Æ·¡¿¡ ¿Å±é´Ï´Ù (EndoTODAY 20130807).

°£°æº¯À¸·Î 3³â 5°³¿ù Àü °£ÀÌ½Ä ¼ö¼úÀ» ¹ÞÀº ȯÀÚ·Î ÃÖ±Ù À§¿¡¼­ high grade dysplasia°¡ ¹ß°ßµÇ¾î ÀǷڵǾú½À´Ï´Ù. ³»½Ã°æ »çÁøÀ» °ËÅäÇÑ ÈÄ À§¾ÏÀÏ °¡´É¼ºÀÌ 50% Á¤µµ´Â µÈ´Ù°í Æò°¡¸¦ ÇÏ¿´À¸¸ç ³»½Ã°æÀýÁ¦¼úÀ» ÃßõÇÏ¿´½À´Ï´Ù. ESD¸¦ ½ÃÇàÇÏ¿´°í ¾Æ·¡¿Í °°Àº º´¸®°á°ú¸¦ ¾ò¾î complete resectionÀ¸·Î ÆÇÁ¤ÇÏ¿´½À´Ï´Ù.

º´¸®°á°ú: Tubular adenocarcinoma, well differentiated, 2.4x0.9cm, Depth of invasion : invades mucosa (muscularis mucosa), Resection margin: free from carcinoma

°£À̽ÄÀ» ¹ÞÀº ȯÀÚ¿´À¸¹Ç·Î ½Ã¼ú Àü ¸é¿ª¾ïÁ¦Á¦¸¦ ¾î¶»°Ô Á¶ÀýÇÒ °ÍÀΰ¡·Î °í¹ÎÀ» ÇÏ¿´½À´Ï´Ù (tacrolimus¿Í mycophenolate¸¦ »ç¿ëÇÏ°í ÀÖ¾úÀ½). ¿Ü°ú ´ã´ç ¼±»ý´Ô°ú »óÀÇÇÏ¿© "°£ÀÌ½Ä ¹ÞÀº Áö ¿À·¡ µÇ¾ú°í, ÇöÀç °£±â´É Á¤»óÀ̹ǷΠ¸é¿ª¾ïÁ¦Á¦¸¦ 1~2ÀÏ Áß´ÜÇÏ´Â °ÍÀº Å©°Ô ¹«¸®°¡ ¾ø°Ú´Ù"´Â ´äº¯À» ¹Þ°í 2ÀÏ°£ Åõ¾àÀ» ÁßÁöÇÏ¿´½À´Ï´Ù. ÀÌ È¯ÀÚÀÇ °æ¿ì´Â ¹®Á¦¾øÀÌ Åð¿øÀ» Çϼ̽À´Ï´Ù¸¸, °£ À̽ÄÀ» ¹ÞÀº Áö ¾ó¸¶µÇÁö ¾ÊÀº ȯÀÚ°¡ ¿À½Å´Ù¸é ¾î¶»°Ô ÇÒÁö °í¹ÎÀÌ µË´Ï´Ù. Individualize ÇÒ ¼ö ¹Û¿¡ ¾ø´Â ¹®Á¦¶ó°í »ý°¢ÇÕ´Ï´Ù.


Mixed histology in ESD candidates

¿¬¼¼´ëÇб³ °­³²¼¼ºê¶õ½ºº´¿ø ±èÁöÇö ±³¼ö´ÔÆÀ¿¡¼­ ¼ö¼ú ȯÀÚÀÇ º´¸®°á°ú¸¦ »õ·Î¿î °¢µµ·Î ºÐ¼®ÇÑ ³í¹®ÀÌ ¹ßÇ¥µÇ¾ú½À´Ï´Ù (Yoon HJ. Pathol Res Pract 2016).

Á¦°¡ Èï¹Ì·Ó°Ô º» °ÍÀº ESD ÀûÀÀÁõ¿¡ ÇØ´çÇϴ ȯÀÚÀÇ ¸²ÇÁÀý ÀüÀÌ ¾ç»óÀÔ´Ï´Ù. ÀÚ·á°¡ ÃàÀûµÉ¼ö·Ï 'ÀϺΠexpanded indication¿¡¼­ ¸²ÇÁÀý ÀüÀÌ°¡ ºÐ¸íÈ÷ Á¸ÀçÇÑ´Ù'´Â °ÍÀÌ ¸í¹éÇØÁö°í ÀÖ½À´Ï´Ù. 3 cm ÀÌÇÏÀÇ ºÐÈ­Çü Á¡¸·¾Ï¿¡¼­µµ ±Ë¾çÀÌ ÀÖ´Â °æ¿ì¿¡´Â ¸²ÇÁÀý ÀüÀ̸¦ ¹Ýµå½Ã °í·ÁÇØ¾ß ÇÒ °Í °°½À´Ï´Ù. Á¡¸·ÇϾÏÀº ¸»ÇÒ ³ªÀ§µµ ¾ø½À´Ï´Ù.

ÀÌ ¿¬±¸ÀÇ ³»¿ëÀ» óÀ½ º» °ÍÀº 2014³â KINGCA¿´½À´Ï´Ù (¸µÅ©). ´ç½Ã Á¦°¡ comment ÇÏ¿´´ø ³»¿ëÀ» ¾Æ·¡¿¡ ¿Å±é´Ï´Ù.

¿¬¼¼´ëÇб³¿¡¼­ 'Is new criteria for mixed histology is necessary for endoscopic resection in EGC?'¶ó´Â Á¦¸ñÀÇ ¹ßÇ¥¸¦ ÇÏ¿´½À´Ï´Ù. Á¦°¡ Èï¹Ì·Ó°Ô º» °ÍÀº Japanese classificationÀÔ´Ï´Ù. ¿ì¸®´Â ÈçÈ÷ ÀϺ»¿¡¼­ ¸»ÇÏ´Â differentiated cancer´Â WHO ºÐ·ù·Î well-differentiated¿Í moderately-differentiated adenocarcinoma¸¦ ÇÕÇÑ °Í°ú ºñ½ÁÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù. ±×·±µ¥ À̹ø ¹ßÇ¥¸¦ º¸´Ï ÀϺ» ºÐ·ù¿¡¼­ differentiated°¡ 49.7%ÀÎ ¹Ý¸é well-differentiated¿Í moderately-differentiated adenocarcinomaÀÇ ÇÕÀº 48%¿´½À´Ï´Ù. Áï 2% Â÷ÀÌ°¡ ÀÖ½À´Ï´Ù. ÀÌ È¯ÀÚµéÀº ¾î¶² Á¶Á÷ÇÐÀû Ư¡ÀÎ ÀÖ´ÂÁö ±Ã±ÝÇÒ »ÓÀÔ´Ï´Ù. ÀϺ» ºÐ·ù¸¦ WHO ºÐ·ù¿Í mappingÇÏ´Â ÀÏÀº ¹«Ã´ ¾î·Á¿î ÀÏÀÔ´Ï´Ù. 2 ÇÁ·Î ºÎÁ·ÇÕ´Ï´Ù.

ÁÁÀº ³í¹® ÃàÇÕ´Ï´Ù.


Non-Helicobacter bacteria in the stomach

¼­¿ï´ë ±è³ª¿µ ±³¼ö´Ô²²¼­ À§Á¡¸·¿¡¼­ Ç︮ÄÚ¹ÚÅÍ ÀÌ¿ÜÀÇ nitrosating or nitrate-reducing bacteriaÀÇ Á¸À縦 pyrosequencingÀ¸·Î ã¾Æº» °á°ú¸¦ ¹ßÇ¥Çϼ̽À´Ï´Ù (Jo HJ. Helicobacter 2016 - Epub).

RESULTS: The number of NB other than HP (non-HP-NB) was two times higher in the cancer groups than in the control groups, but it did not reach statistical significance. The number of non-HP-NB tends to increase over time, but this phenomenon was prevented by HP eradication in the HP-positive control group, but not in the HP-positive cancer group.

CONCLUSION: We could not find the significant role of bacteria other than HP in the gastric carcinogenesis.

ÀÌ ±×¸²ÀÇ Àǹ̴ ¹«¾ùÀϱî?


Role of second look endoscopy after gastric ESD

ESD ÈÄ ÀÌÂ÷ ³»½Ã°æ (second look endoscopy, SLE)ÀÇ À¯¿ë¼º¿¡ ´ëÇÑ »õ·Î¿î ºÐ¼®ÀÔ´Ï´Ù (Kim SJ. World J Gastrointest Endoc 2016 - Epub). ¹®Çå¿¡¼­ Á¦½ÃµÈ Ç¥¿Í °°ÀÌ ESD ÈÄ ÀÌÂ÷ ³»½Ã°æÀÇ À¯¿ë¼ºÀ» °ËÁõÇÑ ¸ðµç ³í¹®Àº negative date¿´½À´Ï´Ù.

À̹ø ¹®Çå¿¡´Â °íÀ§Çè ȯÀÚ¿¡¼­ ¼±ÅÃÀûÀÎ ÀÌÂ÷ ³»½Ã°æÀº µµ¿òµÉÁö ¸ð¸¥´Ù´Â ¾ð±ÞÀÌ ÀÖ½À´Ï´Ù ("SLE might be an important tool for the prevention of the delayed bleeding in selected high-risk patients"). ±×·¯³ª Àú´Â ÀÌ¿Í °°Àº ¾ð±ÞÀ» ½Å·ÚÇÏÁö ¾Ê½À´Ï´Ù. ±âÁ¸ ¿¬±¸¿¡¼­ ÀÌÂ÷ ³»½Ã°æÀÇ È¿°ú°¡ ¿¹¿Ü¾øÀÌ ºÎÁ¤µÇ¾ú°í, ÃâÇ÷ ÀÚüÀÇ ºóµµ°¡ ³·°í, ÀÔ¿ø ȯÀÚÀÇ ÃâÇ÷Àº Àß °ü¸®µÉ ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù.

ÀúÀÇ °á·ÐÀº ÀÌ·¸½À´Ï´Ù. "ESD ÈÄ second look endoscopyÀÇ ¿ªÇÒÀº ÀÔÁõµÈ ¹Ù ¾ø½À´Ï´Ù. Áö±Ý±îÁö ¸ðµç ¿¬±¸´Â negative °á·ÐÀÔ´Ï´Ù."

* Âü°í: EndoTODAY ESD ÈÄ ÀÌÂ÷ ³»½Ã°æ


Colonoscopy surveillance after colorectal cancer resection

´ëÀå¾Ï ¼ö¼ú ÈÄ ´ëÀå³»½Ã°æ¿¡ ´ëÇÑ US multi-society task force °¡À̵å¶óÀÎÀÌ ³ª¿Ô½À´Ï´Ù (Kahi CJ. GIE 2016). ´ëÀå¾Ï ¼ö¼ú 1³â ÈÄ ´ëÀå³»½Ã°æÀ» ÇÏ°í, ¹®Á¦°¡ ¾øÀ¸¸é 3³â ÈÄ(=¼ö¼ú 4³â ÈÄ), ¶Ç ¹®Á¦°¡ ¾øÀ¸¸é 5³â ÈÄ(=¼ö¼ú 9³â ÈÄ)¿¡ °Ë»çÇϵµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­´Â Á¶±Ý ´õ ÀÚÁÖ ÇÒ ¼ö ÀÖ°ÚÁö¸¸, ±×·¸´Ù°í ³Ê¹« ÀÚÁÖ ÇÏ´Â °ÍÀº ÁÁÁö ¾Ê´Ù°í »ý°¢ÇÕ´Ï´Ù. ¿¹¸¦ µé¾î ¸Å³â °Ë»çÇÏ´Â °ÍÀº ºÐ¸í overÀÔ´Ï´Ù.

Recommendation: We recommend that patients who have undergone curative resection of either colon or rectal cancer receive their first surveillance colonoscopy 1 year after surgery (or 1 year after the clearing perioperative colonoscopy).

Recommendation: We recommend that, after the 1-year colonoscopy, the interval to the next colonoscopy should be 3 years (ie, 4 years after surgery or perioperative colonoscopy) and then 5 years (ie, 9 years after surgery or perioperative colonoscopy). Subsequent colonoscopies should occur at 5-year intervals until the benefit of continued surveillance is outweighed by diminishing life expectancy. If neoplastic polyps are detected, the intervals between colonoscopies should be in accordance with published guidelines for polyp surveillance intervals. These intervals do not apply to patients with Lynch syndrome.


Clip artifact

´ëÀå ESD ÈÄ clip¿¡ ÀÇÇÑ artifact¸¦ º¸¿©ÁÖ´Â Èï¹Ì·Î¿î ³í¹®ÀÌ ÀÖ¾ú½À´Ï´Ù (Pellise M. GIE 2016). Ư¡Àº "nodular elevation of the mucosa with a normal pit pattern"¶ó°í ÇÕ´Ï´Ù.


°£Áú (Biliary fascioliasis diagnosed by EUS)

¿ì»óº¹ºÎ ÅëÁõÀ¸·Î ³»¿øÇÑ 46¼¼ ¿©¼º¿¡¼­ EUS·Î Áø´ÜÇÏ°í ERCP·Î Á¦°ÅÇÑ °£Áú Áõ·Ê°¡ º¸°íµÇ¾ú½À´Ï´Ù (Mohamadnejad M. GIE 2016). À̶õ Áõ·Ê¿´½À´Ï´Ù. EUS¿¡¼­ "mobile, free-floating cylindrical, nonshadowing filling defects"·Î º¸¿´´Ù°í ÇÕ´Ï´Ù.

* Âü°í: EndoTODAY °£Áú (Fasciola hepatica)


´ëÀå ESD õ°ø

È«¼º³ë ±³¼ö´Ô²²¼­ ³»½Ã°æÇÐȸ ESD ¿¬±¸È¸ registry data¸¦ ÀÌ¿ëÇÏ¿© ´ëÀå ESD õ°ø ¿¹Ãø ¸ðµ¨À» °³¹ßÇÏ¿´½À´Ï´Ù(Hong SN. GIE 2016 - Epub). ¾Æ·¡ 4°³ ÀÎÀÚ°¡ Áß¿äÇÏ´Ù°í ÇÕ´Ï´Ù.

The risk score points attributed to each risk factor were weighted according to respective adjusted ORs in multivariate logistic regression of the derivation set. Respective adjusted ORs were rounded to the nearest whole number to keep the score simple. Points were assigned to each predictor for ESD-induced perforation as follows: tumor located in the colon (+2 points), tumor size at 1-cm increments (+1 point with 1-cm increments), endoscopist experience of greater than or equal to 50 ESDs (-1 point), and submucosal fibrosis (+2 points).

Á¦°¡ ´õ Èï¹Ì·Ó°Ô º» °ÍÀº õ°øÀÇ ºóµµ¿Í ÇüÅ¿´½À´Ï´Ù. õ°øÀÇ ºóµµ°¡ 6.6%(135/2,046)·Î Á¦ ÁüÀÛº¸´Ù ´Ù¼Ò ³ô¾Ò½À´Ï´Ù. MicroperforationÀÌ frank perforationº¸´Ù 3¹è °¡·® ÈçÇß´Ù´Â Á¡µµ Á¶±Ý ÀÇ¿Ü¿´½À´Ï´Ù. À§ ESD¿Í ´ëÀå ESD´Â »ç¹µ ´Ù¸¥ ¸ð¾çÀÔ´Ï´Ù.

»ç½Ç Àú´Â ´ëÀå ESD¿¡ ´ëÇÏ¿© ¹¹¶ó ¸»ÇÒ ÀÔÀåÀÌ ¾Æ´Õ´Ï´Ù. °æÇèÀÌ ¾ø±â ¶§¹®ÀÌÁö¿ä. ÀúÀÇ Ã³À½ÀÌÀÚ ¸¶Áö¸· ´ëÀå ESDÀÔ´Ï´Ù. Dual knife³ª Flex knife°¡ ¾ø¾ú±â¿¡ »ÏÁ·ÇÑ needle knife·Î circumferential cuttingÀ» ÇÏ´ø Áß frank perforationÀÌ ¹ß»ýÇÏ¿© clippingÇÏ¿´½À´Ï´Ù. óÀýÇÑ ½ÇÆп´½À´Ï´Ù. ÀÌ È¯ÀÚ ÀÌÈķδ »óºÎ ESD¸¸ ÇÏ°í ÀÖ½À´Ï´Ù.^^

ÁÁÀº ¿¬±¸ ÃàÇÏÇÕ´Ï´Ù.


¼öÀÔ¿¡ µû¶ó À§¾Ï Ä¡·á°¡ ´Þ¶óÁø´Ù?

'Relationship between socioeconomic status and accessibility for endoscopic resection among gastric cancer patients'¶ó´Â Èï¹Ì·Î¿î ³í¹®À» ¼Ò°³ÇÕ´Ï´Ù (Kim NY. Gastric Cancer 2016). À§¾Ï ȯÀÚ Áß ¼ÒµæÀÌ ³·Àº 20% ȯÀÚµéÀº ´Ù¸¥ ¼Òµæ±º¿¡ ºñÇÏ¿© ³»½Ã°æÄ¡·á¸¦ ¹ÞÀ» È®·üÀÌ ³·´Ù°í ÇÕ´Ï´Ù. °¡Àå ¼ÒµæÀÌ ³ôÀº 20%¿¡ ºñÇÏ¿© odds ratio°¡ 0.56ÀÌ¿´½À´Ï´Ù. ±âÀüÀº ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. ÀúÀÚµéÀº ¾Æ¸¶µµ °¡³­ÇÑ »ç¶÷µéÀÌ °ËÁøÀ» ´ú ¹Þ±â ¶§¹®ÀÏ °ÍÀ¸·Î Ãß·ÐÇÏ°í ÀÖ½À´Ï´Ù. °ü·Ã µ¥ÀÌŸ´Â Á¦½ÃÇÏÁö ¸øÇßÁö¸¸...

¿ì¸®³ª¶óó·³ ÀÇ·áºñ°¡ ½Ñ ³ª¶ó¿¡¼­µµ ¼Òµæ¿¡ µû¶ó ÀÇ·áÀÌ¿ëÀº »ó´çÈ÷ ´Ù¸¨´Ï´Ù. ½Ñ °¡°ÝÀ¸·Î ¸ðµç °ÍÀ» ÅëÁ¦ÇÏ·Á´Â Á¤ºÎÀÇ ½Ãµµ´Â ½ÇÆÐÇÒ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. Àú¼Òµæ±ºÀÇ °Ç°­¼öÁØÀ» ³ôÀ̱â À§Çؼ­´Â °¡°Ý ÇÒÀÎ ÀÌ¿ÜÀÇ ´ëÃ¥ÀÌ ÇÊ¿äÇÕ´Ï´Ù. °ø°øÀǷḦ È®´ëÇØ¾ß ÇÏ´Â °ÍÀÌÁö¿ä.


Gastric cancer screening in USA

ºÎ»ê´ëÇб³ ±è±¤ÇÏ ±³¼ö´Ô²²¼­ ¹Ì±¹ ¿¬¼ö Áß¿¡ GIE¿¡ Åõ°íÇÑ Á¾¼³ÀÌ ³ª¿Ô½À´Ï´Ù (Kim GH. GIE 2016 - Epub). Á¦¸ñÀº "Screening and Surveillance for Gastric Cancer in the United States: Is it needed?" À§¾ÏÀÌ ¸¹Àº ³ª¶ó¿¡¼­ ¿Â À̹ÎÀÚ³ª À§¾Ï °¡Á··ÂÀÌ ÀÖ´Â »ç¶÷¿¡¼­´Â °ËÁøÀÌ ÇÊ¿äÇÏ´Ù°í ÁÖÀåÇϼ̽À´Ï´Ù.


ÀÜÀ§¾Ï¿¡ ´ëÇÑ ÃÖ±Ù Á¾¼³ (Ohira. WJG 2016)

¿øÀ§ À§ÀýÁ¦¼ú ÈÄ lymphatic drainage ¾ç»ó¿¡ º¯È­°¡ ÀϾ´Ï´Ù. ¾Æ¸¶µµ ¼ö¼ú °úÁ¤¿¡¼­ Á¤»óÀûÀÎ lymphatics°¡ ÀýÁ¦µÇ±â ¶§¹®ÀÏ °ÍÀÔ´Ï´Ù. ±× °á°ú ÀÜÀ§¾Ï°ú ¿ø¹ß¼º ±ÙÀ§ºÎ À§¾Ï(primary proximal gastric cancer)ÀÇ ¸²ÇÁÀý ÀüÀÌ¿¡ ¾à°£ÀÇ Â÷ÀÌ°¡ ¹ß°ßµË´Ï´Ù. ÀÜÀ§¾Ï¿¡¼­´Â splenic artery (11¹ø), splenic hilum (10¹ø), lower mediastinum (110, 111¹ø), jejunal mesenteryÀÇ ¸²ÇÁÀý ħÀ±ÀÌ ÈçÇÕ´Ï´Ù.

It has been reported that RGC has unique patterns of lymph node metastasis compared with PPGC. In PPGC, the main lymphatic flow drains to the lymph nodes along the celiac artery through the lymph nodes at the lesser curvature, the left gastric artery, and the right side of the cardia. In RGC, it has been considered that the characteristics of lymph node metastases are different from PPGC because abnormal lymphatic formation is induced as a result of cutting off these lymphatic pathways at the initial surgery. Furthermore, Tokunaga et al mentioned that altered lymphatic drainage after DG may affect the long-term survival of RGC patients with advanced stage disease. Previous studies have investigated the incidence of lymph node metastasis focusing on around the splenic artery, in the splenic hilum, at the lower mediastinum, and in the jejunal mesentery. Some authors demonstrated a higher incidence of lymph node metastasis around the splenic artery, in the splenic hilum, and at the lower mediastinum in RGC; therefore, lymphadenectomy of these regions is recommended for curative surgery. In patients with previous B-II reconstruction, the rate of lymph node metastases in the jejunal mesentery has been reported to be 10.0%-67%. Thorban et al reported that RGC patients with lymph node metastases in the jejunal mesentery had a poor prognosis, with a median survival time (MST) of 13.2 mo. Similarly, Leo et al reported that RGC patients with lymph node metastases in the jejunal mesentery had worse outcomes than those with metastases in other lymph node stations. Therefore, jejunal mesentery lymph node dissection including the origins of each involved jejunal artery is recommended for RGC patients with previous B-II reconstruction. However, the details of the spread of lymph node metastases in RGC patients are still uncertain, because the number of patients examined in these studies was too small. (Ohira. WJG 2016)


¹Ì±¹¿Í ÀϺ»ÀÇ ÈäºÎ ¸²ÇÁÀý ¸í¸í¹ýÀÌ ¼­·Î ´Ù¸¨´Ï´Ù. À§ table¿¡¼­ ¾ð±ÞµÈ 110, 111¹øÀº ÀϺ»½ÄÀÔ´Ï´Ù. ¹Ì±¹ ÈäºÎ¿Ü°úÂÊ¿¡¼­´Â Á¶±Ý ´Ù¸£°Ô ºÎ¸¨´Ï´Ù. ¿¹¸¦ µé¾î lower paratracheal nodes´Â ÀϺ»½ÄÀ¸·Î´Â 110¹ø, ¹Ì±¹½ÄÀ¸·Î´Â 8L¹øÀÔ´Ï´Ù.

À§Ä¡¼­¾ç½ÄÀϺ»½Ä
Lower paratracheal nodes8L110
Diaphragmatic nodes15111
Paracardial nodes161 (éÓ) ¶Ç´Â 2 (ñ§)

1) AJCC 7ÆÇ¿¡ µû¸¥ ¸²ÇÁÀý ¸í¸í¹ý

1L = left supraclavicular, 1R = right supraclavicular, 2L = left upper paratracheal, 2R = right upper paratracheal, 4L = left lower paratracheal, 4R = right lower paratracheal, 5 = aortopulmonary, 6 = anterior mediastinal, 7 = subcarinal, 8L = lower paraesophageal, 8M = middle paraesophageal, 9 = pulmonary ligament, 10L = left tracheobronchial, 10R = right tracheobronchial, 15 = diaphragmatic, 16 = paracardial, 17 = left gastric, 18 = common hepatic, 19 = splenic, 20 = celiac. The posterior mediastinal lymph node (3P) is not shown.

2) ÀϺ» ½ÄµµÁúȯÇÐȸ ¸²ÇÁÀý ¸í¸í¹ý (Esophagus 2004;1:61-88)



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