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Tsekrekos A, Okumura Y, Rouvelas I, Nilsson M. Gastric Cancer Surgery: Balancing Oncological Efficacy against Postoperative Morbidity and Function Detriment. Cancers (Basel) 2024; 16:1741. [PMID: 38730693 PMCID: PMC11083646 DOI: 10.3390/cancers16091741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Significant progress has been made in the surgical management of gastric cancer over the years, and previous discrepancies in surgical practice between different parts of the world have gradually lessened. A transition from the earlier period of progressively more extensive surgery to the current trend of a more tailored and evidence-based approach is clear. Prophylactic resection of adjacent anatomical structures or neighboring organs and extensive lymph node dissections that were once assumed to increase the chances of long-term survival are now performed selectively. Laparoscopic gastrectomy has been widely adopted and its indications have steadily expanded, from early cancers located in the distal part of the stomach, to locally advanced tumors where total gastrectomy is required. In parallel, function-preserving surgery has also evolved and now constitutes a valid option for early gastric cancer. Pylorus-preserving and proximal gastrectomy have improved the postoperative quality of life of patients, and sentinel node navigation surgery is being explored as the next step in the process of further refining the minimally invasive concept. Moreover, innovative techniques such as indocyanine green fluorescence imaging and robot-assisted gastrectomy are being introduced in clinical practice. These technologies hold promise for enhancing surgical precision, ultimately improving the oncological and functional outcomes.
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Affiliation(s)
- Andrianos Tsekrekos
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, 141 52 Stockholm, Sweden; (A.T.); (Y.O.); (I.R.)
- Department of Surgery, University Hospital of Umeå, 907 19 Umeå, Sweden
| | - Yasuhiro Okumura
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, 141 52 Stockholm, Sweden; (A.T.); (Y.O.); (I.R.)
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 57 Stockholm, Sweden
| | - Ioannis Rouvelas
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, 141 52 Stockholm, Sweden; (A.T.); (Y.O.); (I.R.)
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 57 Stockholm, Sweden
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, 141 52 Stockholm, Sweden; (A.T.); (Y.O.); (I.R.)
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 57 Stockholm, Sweden
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Imai Y, Tanaka R, Matsuo K, Asakuma M, Lee SW. Oncological relevance of proximal gastrectomy in advanced gastric cancer of upper third of the stomach. Surg Open Sci 2024; 18:23-27. [PMID: 38312305 PMCID: PMC10832503 DOI: 10.1016/j.sopen.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/22/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Background The oncological relevance of proximal gastrectomy in advanced gastric cancer remains unclear. We aimed to examine the frequency of lymph node metastasis in advanced gastric cancer to determine the oncological validity of proximal gastrectomy selection. Materials and methods This study included consecutive 71 patients with locally advanced gastric cancer in the upper third of the stomach who underwent total gastrectomy at our institution between 2001 and 2017. Lymph node metastasis and its therapeutic value index were examined to identify candidates for proximal gastrectomy. Metastatic and 3-year overall survival rates of numbers 3a and 3b lymph nodes were examined from 2010 to 2019. Results The metastatic rate and therapeutic value index of numbers 4d, 5, 6, and 12a lymph nodes were zero or low. The number 3 lymph node had a metastatic rate and therapeutic value index of 36.6 % and 31.1, respectively. The metastatic and 3-year overall survival rates of the number 3a lymph node were 32.7 % and 89 %, respectively, whereas those of the number 3b lymph node were 3.8 % and 100 %, respectively. All patients with positive metastasis to the number 3b lymph node received adjuvant chemotherapy. Histopathological findings of positive metastasis to the number 3b lymph node were located in the lesser curvature, and the tumor diameter exceeded 40 mm. Conclusion For advanced gastric cancer of the upper third of the stomach, the indications of localization to the lesser curvature and a tumor diameter of >40 mm should be considered cautiously.
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Affiliation(s)
- Yoshiro Imai
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Ryo Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Kentaro Matsuo
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Mitsuhiro Asakuma
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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3
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Kinoshita T, Okayama T. Is splenic hilar lymph node dissection necessary for proximal gastric cancer surgery? Ann Gastroenterol Surg 2021; 5:173-182. [PMID: 33860137 PMCID: PMC8034691 DOI: 10.1002/ags3.12413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
Advanced proximal gastric cancer sometimes metastasizes to the splenic hilar lymph nodes (No. 10 LN). Total gastrectomy combined with splenectomy is performed for complete removal of the No. 10 LN and was historically a standard procedure in Japan. However, splenectomy is associated with several disadvantages for patients, such as increased postoperative morbidity, risk of thrombogenic disease, fatal infection from encapsulated bacteria, and the development of other types of cancer in the long term because of loss of immune function. Therefore, splenectomy should only be performed when its estimated oncological effect exceeds such disadvantages. A Japanese randomized controlled trial (JCOG0110) clearly demonstrated that prophylactic splenectomy is not necessary unless the tumor has invaded the greater curvature; thus, splenectomy is no longer routinely performed in Japan. However, several retrospective studies have shown a comparatively high incidence of No. 10 LN metastasis and therapeutic value from LN dissection at that station in the tumors invading the greater curvature. Similar tendencies have also been reported in type 4 or remnant gastric cancer involving the greater curvature. In view of these facts, No. 10 LN dissection is presently recommended for such patients; however, robust evidence is lacking. In recent years, laparoscopic/robotic spleen-preserving splenic hilar dissection utilizing augmented visualization without pancreatic mobilization has been developed. This procedure is expected to replace prophylactic splenectomy and provide an equal oncological effect with lower morbidity. In Japan, a prospective phase-II study (JCOG1809) is currently ongoing to investigate the safety and feasibility of this procedure.
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Affiliation(s)
- Takahiro Kinoshita
- Gastric Surgery DivisionNational Cancer Center Hospital EastKashiwaJapan
| | - Takafumi Okayama
- Gastric Surgery DivisionNational Cancer Center Hospital EastKashiwaJapan
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Khalayleh H, Kim YW, Yoon HM, Ryu KW. Assessment of Lymph Node Metastasis in Patients With Gastric Cancer to Identify Those Suitable for Middle Segmental Gastrectomy. JAMA Netw Open 2021; 4:e211840. [PMID: 33729506 PMCID: PMC7970333 DOI: 10.1001/jamanetworkopen.2021.1840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Segmental gastrectomy, a type of function-preserving surgery, is not broadly studied but can improve postoperative function and quality of life among patients with gastric cancer (GC). OBJECTIVE To establish an indication for middle segmental gastrectomy (MSG) as a treatment for middle-body (MB) and high-body (HB) GC. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed patients with GC undergoing surgery between January 2000 and December 2015 in the National Cancer Center, Goyang, Korea, a high-volume cancer center with a structured database and accurate long-term follow-up. Inclusion criteria were age 18 to 85 year, histologically proven adenocarcinoma located in the HB or MB, cT1 to cT3 category cancers, curative resection with negative margins performed, and follow-up for at least 3 years. Exclusion criteria were Borrmann type 4 GC, T4 category cancer, neoadjuvant chemotherapy, and a history of other cancers. Data analysis was performed from December 2018 to May 2020. EXPOSURES Total or subtotal gastrectomy and LN dissection. MAIN OUTCOME AND MEASURES The primary outcome was the rate of metastasis at LN stations 2, 4sa, 5, 6, and 11d, which cannot be dissected during MSG. RESULTS Among 9952 patients who underwent surgery for GC, 8219 underwent either laparoscopic or open total or subtotal gastrectomy. Seven hundred seventy-three patients (mean [SD] age, 56.21 [12.16] years; 464 men [60.0%]) had GC in the MB or HB of the stomach. Among the 701 patients included in the final analysis after exclusion of the cN2/N3 carcinomas, the mean (SD) age was 56.35 (12.24) years, and 418 (59.6%) were men. The incidence of LN metastasis was 0% at station 5 for cT1-3N0/1M0 cancers, station 4sa for cT1-2N0/1M0 cancers, station 2 for cT1N0/1M0 cancers, station 6 for cT1N1M0 cancers, station 11d for cT1N1M0-cT2N0/1M0 cancers, and station 12a for cT1N0/1M0-T2N1M0 cancers, regardless of size and differentiation. The rates of LN metastasis for cT1N0M0 cancers were 0.3% (1 of 396 LNs) at station 6 and 0.8% (1 of 129 LNs) at station 11d. Tumors 4 cm or smaller were associated with a lower risk of LN metastasis compared with tumors 4.1 cm or larger (odds ratio, 2.10; 95% CI, 1.20-3.67; P = .009), and well-differentiated tumors were associated with lower risk of LN metastasis compared with poorly differentiated tumors (odds ratio, 2.88; 95% CI, 1.45-5.73; P = .002). CONCLUSIONS AND RELEVANCE These findings suggest that MSG with dissection of stations 1, 3, 4sb, 4d, 7, 8a, 9, 11p, and 12a could be done for HB and MB cT1N0/1M0 gastric cancers 4 cm or smaller and well-differentiated cT2N0/1M0 cancers.
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Affiliation(s)
- Harbi Khalayleh
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Department of Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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Khalayleh H, Kim YW, Man Yoon H, Ryu KW, Kook MC. Evaluation of Lymph Node Metastasis Among Adults With Gastric Adenocarcinoma Managed With Total Gastrectomy. JAMA Netw Open 2021; 4:e2035810. [PMID: 33566106 PMCID: PMC7876588 DOI: 10.1001/jamanetworkopen.2020.35810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE It is unclear whether proximal gastrectomy (PG) can replace total gastrectomy (TG), even in cases of advanced gastric carcinoma. OBJECTIVES To evaluate the oncologic safety of PG based on the lymph node (LN) metastasis rate and develop a selection diagram for PG eligibility. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, a retrospective analysis of a prospective database of gastric carcinoma surgery was performed including procedures that took place between December 1, 2000, and December 31, 2015, in the National Cancer Center, Korea, a high-volume carcinoma center with a structured database and accurate long-term follow-up. Among 9952 patients who underwent surgery for gastric carcinoma, 2347 underwent TG. Six-hundred fifty-five (564 in a second statistical analysis) had gastric carcinoma in the upper third of the stomach. The inclusion criteria were age 18 to 85 years, histologically proven adenocarcinoma (any size or differentiation) located in the upper third of the stomach, curative R0 TG performed, and postoperative follow-up for at least 3 years. Exclusion criteria included Borrmann type 4 carcinoma, T4 category, use of neoadjuvant chemotherapy, and a history of other carcinomas. Data analysis was performed from December 1, 2019, to May 30, 2020. EXPOSURES Total gastrectomy and LN dissection. MAIN OUTCOMES AND MEASURES The primary end point was the rate of LN metastasis at LN stations 4d, 5, and 6, which are usually not dissected during PG. RESULTS Among the 655 study patients, the mean (SD) age was 57.7 (11.9) years, and 462 (70.5%) were men. Only those with poorly differentiated cT3 category carcinomas had an increased incidence of LN metastasis at stations 4d (2 of 32 [6.3%]) and 11d (T3N0: 2 of 22 [9.1%], T3N1: 3 of 27 [11.1%]), independent of tumor size. For cT1-T3N0/1M0 category carcinomas, the incidence of station 5 LN metastasis was 0, irrespective of tumor size and differentiation. The LN metastasis rate at stations 4d and 6 for cT1-T3N0/1M0 differentiated tumors was also 0. Tumor size greater than or equal to 4.1 cm was associated with significantly increased LN metastasis compared with tumors less than 4.1 cm (40.0% vs 20.4%, P = .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that PG can be safely performed for cT1-T2N0/1M0 tumors less than 4.1 cm in diameter that are located in the upper third of the stomach. The cT3N0/1M0-differentiated tumors less than 4.1 cm may also be eligible for PG, whereas poorly differentiated cT3 tumors and any cT4 or cN2/3 diseases require TG.
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Affiliation(s)
- Harbi Khalayleh
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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Yang K, Zang ZY, Niu KF, Sun LF, Zhang WH, Zhang YX, Chen XL, Zhou ZG, Hu JK. The Survival Benefit and Safety of Splenectomy for Gastric Cancer With Total Gastrectomy: Updated Results. Front Oncol 2021; 10:568872. [PMID: 33585191 PMCID: PMC7873941 DOI: 10.3389/fonc.2020.568872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/10/2020] [Indexed: 02/05/2023] Open
Abstract
Background Splenectomy was traditionally performed to dissect the splenic hilar lymph nodes. Considering the important functions of spleen, whether splenectomy would bring beneficial to gastric cancer patients is debatable. This meta-analysis aimed to make an updated evaluation on the effectiveness and safety of splenectomy. Methods Literature searches were performed to identify eligible RCTs concerning effectiveness or safety of splenectomy with gastrectomy from PubMed, MEDLINE, CBMdisc, EMBASE, and Cochrane Central Register of Controlled Trials. Two reviewers completed the study selection, data extraction, and quality assessment independently. The meta-analyses were performed by RevMan 5.3. Results A total of 971 patients from four studies were included (485 in splenectomy group and 486 in spleen preservation group). Splenectomy did not increase 5-year overall survival rate (RR=1.05, 95% CI: 0.96, 1.16) or increase postoperative mortality (RR=1.21, 95% CI: 0.41, 3.54). However, the analysis demonstrated that gastrectomy with splenectomy had significantly higher incidence of postoperative complications (RR=1.80, 95% CI: 1.33, 2.45). No significant differences were found in terms of the number of resected lymph nodes and reoperation rate; however, splenectomy had a tendency to prolong the duration of surgery and hospital stays. Subgroup analyses indicated that splenectomy could not increase overall survival rate for either whole or proximal gastric cancer. Sensitivity analyses also found similar results compared to the primary analyses. Conclusions Splenectomy cannot benefit the survival of patients with tumor located at lesser curvature, and it could instead increase postoperative morbidity.
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Affiliation(s)
- Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi-Yun Zang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Kai-Fan Niu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Li-Fei Sun
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yue-Xin Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Long Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Toriumi T, Terashima M. Disadvantages of Complete No. 10 Lymph Node Dissection in Gastric Cancer and the Possibility of Spleen-Preserving Dissection: Review. J Gastric Cancer 2020; 20:1-18. [PMID: 32269840 PMCID: PMC7105416 DOI: 10.5230/jgc.2020.20.e8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/17/2020] [Indexed: 11/20/2022] Open
Abstract
Splenic hilar lymph node dissection has been the standard treatment for advanced proximal gastric cancer. Splenectomy is typically performed as part of this procedure. However, splenectomy has some disadvantages, such as increased risk of postoperative complications, especially pancreatic fistula. Moreover, patients who underwent splenectomy are vulnerable to potentially fatal infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of splenectomy with cancer development and increased risk of thromboembolic events. Therefore, splenectomy should be avoided if it does not confer a distinct oncological advantage. Most studies that compared patients who underwent splenectomy and those who did not failed to demonstrate the efficacy of splenectomy. Based on the results of a randomized controlled trial conducted in Japan, prophylactic dissection with splenectomy is no longer recommended in patients with gastric cancer with no invasion of the greater curvature. However, patients with greater curvature invasion or those with remnant gastric cancer still need to undergo splenectomy to facilitate splenic hilar node dissection. Spleen-preserving splenic hilar node dissection is a new procedure that may help delink splenic hilar node dissection and splenectomy. In this review, we examine the evidence pertaining to the efficacy and disadvantages of splenectomy. We discuss the possibility of spleen-preserving surgery for prophylactic splenic hilar node dissection to overcome the disadvantages of splenectomy.
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Affiliation(s)
- Tetsuro Toriumi
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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8
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Clinicopathological Characteristics and Prognosis of Upper Gastric Cancer Patients in China: A 32-Year Single-Center Retrospective Clinical Study. Gastroenterol Res Pract 2019; 2019:9248394. [PMID: 31885548 PMCID: PMC6914896 DOI: 10.1155/2019/9248394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/04/2019] [Indexed: 01/02/2023] Open
Abstract
Purpose Upper or proximal gastric cancer occurs in the upper third of the stomach between the cardia and a line connecting the greater and lesser curvatures. As it differs from other gastric cancers in pathology and prognosis, we evaluated patient and disease characteristics that might guide improved treatment and survival of upper gastric cancer. Methods We conducted a retrospective analysis of 649 patients with upper gastric cancer and 1551 patients with lower gastric cancer and R0 radical surgery at our institution between January 1980 and December 2012. Results Survival after radical surgery for upper gastric cancer was 77.8% at 1 year, 49.6% at 3 years, and 41.1% at 5 years. The corresponding rates for lower gastric cancer were 85.9%, 60.0%, and 57.2% (p < 0.001). Upper gastric cancer had a poor prognosis. Sex (p = 0.036), tumor diameter (p = 0.001), macroscopic type (p < 0.001), pTM stage (p < 0.001), tissue differentiation type (p = 0.003), and serosal invasion (p = 0.034) were independently associated with lymph node metastasis. The macroscopic type (p = 0.045), lymphovascular tumor emboli (p = 0.021), and pTNM stage were independently associated with recurrence and metastasis. Survival of 333 patients with D2 total gastrectomy was 81.3% at 1 year, 54.4% at 3 years, and 45.2% at 5 years. The corresponding rates for 316 proximal gastrectomy patients were 75.4%, 44.9%, and 36.7%. Radical total gastrectomy had better survival than radical proximal resection. Conclusions Upper gastric cancers were more aggressive, had a worse prognosis, and were more prone to recurrence and metastasis compared with lower gastric cancers. Survival was better after total gastrectomy than after proximal resection.
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The Application of Spleen-Preserving Splenic Regional Laparoscopic Lymphadenectomy with Spleen Kept In Situ and Laparotomy with Spleen Lifted Out of the Abdomen for Locally Advanced Proximal Gastric Cancer: A Retrospective Study. Gastroenterol Res Pract 2019; 2019:4283183. [PMID: 31737066 PMCID: PMC6815632 DOI: 10.1155/2019/4283183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 09/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose Findings whether laparoscopic lymphadenectomy with spleen kept in situ or laparotomy with spleen lifted out of the abdomen is more effective remain inconclusive. This study is aimed at comparing outcomes of spleen-preserving splenic regional laparoscopic lymphadenectomy with spleen kept in situ versus laparotomy with spleen lifted out of the abdomen for locally advanced proximal gastric cancer. Methods Data from patients with locally advanced proximal gastric cancer were collected from January 2011 to January 2014. A total of 246 patients were identified who received D2 radical total gastrectomy together with spleen-preserving splenic regional lymphadenectomy. Of those patients, 87 patients underwent laparoscopic splenic regional lymphadenectomy with spleen kept in situ (LSKS-SRLA) and 159 patients underwent laparotomy with spleen lifted out of the abdomen (LSLA-SRLA). Surgical outcomes and long-term outcomes were compared between the two groups. Results The total number of lymph node dissection, intraoperative blood loss volume, intraoperative injury cases, and postoperative complications had no statistically significant difference between the two groups. The number of splenic regional lymph node dissections was 3.90 ± 1.05 per case in the LSLA-SRLA group and 2.89 ± 1.04 in the LSKS-SRLA group. The operation time, length of the incision, and hospital days were shorter in the LSKS-SRLA group. The total recurrence and metastatic rates and 3-year cumulative survival rate had no statistically significant difference between the two groups. Conclusions Similar long-term outcomes were achieved in the LSKS-SRLA and LSLA-SRLA groups for locally advanced proximal gastric cancer. However, in the aspects of surgical time, length of incision, and postoperative recovery, the LSKS-SRLA group had obvious advantages.
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Zhu Z, Wu P, Du N, Li K, Huang B, Wang Z, Xu H. Surgical choice of proximal gastric cancer in China: a retrospective study of a 30-year experience from a single center in China. Expert Rev Gastroenterol Hepatol 2019; 13:1123-1128. [PMID: 31687853 DOI: 10.1080/17474124.2019.1689816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: Total gastrectomy with D2 lymphadenectomy is indicated for proximal advanced gastric cancer located in the upper one-third of the stomach; however, due to preserved function and clinical benefits of a proximal gastrectomy, the choice of a surgical method for patients with proximal early-stage gastric cancer remains controversial.Methods: We conducted a retrospective study involving 649 patients with proximal gastric cancer. The clinical-pathological features, characteristics, lymph node metastatic patterns, prognosis, postoperative complications, and recurrence were compared between the patients who underwent proximal and total gastrectomies with different T and N stages.Results: The lymph node metastatic rates among T stages were significantly different. There was no difference in overall survival rates for stage Ia, Ib, and IIa patients but significant difference in T3 and T4 stages who underwent proximal and total gastrectomy. Complications were more frequently detected in patients who underwent total gastrectomy than proximal gastrectomy.Conclusion: Considering the survival benefits and preserved function, proximal gastrectomy can be performed safely in stage Ia and Ib gastric cancer (T1N0, T1N1, and T2N0) with an excellent remission rate. Proximal gastrectomy is not recommended for advanced gastric cancer.
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Affiliation(s)
- Zhi Zhu
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Pei Wu
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Nan Du
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Kai Li
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Baojun Huang
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Zhenning Wang
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Huimian Xu
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
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11
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Gao S, Cao GH, Ding P, Zhao YY, Deng P, Hou B, Li K, Liu XF. Retrospective evaluation of lymphatic and blood vessel invasion and Borrmann types in advanced proximal gastric cancer. World J Gastrointest Oncol 2019; 11:642-651. [PMID: 31435465 PMCID: PMC6700032 DOI: 10.4251/wjgo.v11.i8.642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/18/2019] [Accepted: 08/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Borrmann classification system is used to describe the macroscopic appearance of advanced gastric cancer, and Borrmann type IV disease is independently associated with a poor prognosis.
AIM To evaluate the prognostic significance of lymphatic and/or blood vessel invasion (LBVI) combined with the Borrmann type in advanced proximal gastric cancer (APGC).
METHODS The clinicopathological and survival data of 440 patients with APGC who underwent curative surgery between 2005 and 2012 were retrospectively analyzed.
RESULTS In these 440 patients, LBVI+ status was associated with Borrmann type IV, low histological grade, large tumor size, and advanced pT and pN status. The 5-year survival rate of LBVI+ patients was significantly lower than that of LBVI– patients, although LBVI was not an independent prognostic factor in the multivariate analysis. No significant difference in the prognosis of patients with Borrmann type III/LBVI+ disease and patients with Borrmann type IV disease was observed. Therefore, we proposed a revised Borrmann type IV (r-Bor IV) as Borrmann type III plus LBVI+, and found that r-Bor IV was associated with poor prognosis in patients with APGC, which outweighed the prognostic significance of pT status.
CONCLUSION LBVI is related to the prognosis of APGC, but is not an independent prognostic factor. LBVI status can be used to differentiate Borrmann types III and IV, and the same approach can be used to treat r-Bor IV and Borrmann type IV.
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Affiliation(s)
- Shan Gao
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Guo-Hui Cao
- The first department of oncology, Hebei general Hospital, Shijiazhuang, Hebei Province 050051, China
| | - Peng Ding
- Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yang-Yang Zhao
- School of Public Health, China Medical University, Shenyang 110001, Liaoning Province, China
| | - Peng Deng
- Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Bin Hou
- Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Kai Li
- Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xiao-Fang Liu
- Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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12
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Ma Z, Shi G, Chen X, Zhao S, Yang L, Ding W, Wang X. Laparoscopic splenic hilar lymph node dissection for advanced gastric cancer: to be or not to be. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:343. [PMID: 31475213 DOI: 10.21037/atm.2019.07.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The incidence of proximal gastric cancer has increased in both the East and the West. Although some novel reconstructions like double-tract or double-flap anti-reflux procedure related to proximal gastrectomy are promising, total radical gastrectomy still accounts for a significant portion of these procedures. D2 radical gastrectomy is the globally accepted standard surgical procedure for advanced gastric cancer, and lymph node (LN) dissection is considered as the critical point of radical surgery and closely related to the prognosis. The splenic hilar LNs (No. 10) are LNs that need to be removed during standard D2 surgery for proximal and total gastrectomy. Lymphadenectomy does not only provide valuable information on the prognosis of gastric cancer, but the thoroughness of the sweep itself is directly related to postoperative survival. The incidence of splenic hilar LN (No. 10) metastasis rate is not high. Although the LN metastasis pathway around the spleen is complicated, the feasibility of laparoscopic splenic hilar LN dissection in locally advanced gastric cancer has been verified. However, these results are mostly from small volume clinical studies, and the fact is that the dissection of the splenic hilar is technique-demanding even for open surgery. The rational strategy for LN dissection for surgeons is still controversial. For splenic LN dissection in radical gastric cancer surgery, whether to select individualized splenic LN dissection for those patients highly suspected of clinical metastasis or to advocate the evidence-based strategy and neglect dissection in lower risk patients to avoid over-removing of LNs, is a vital question that needs to be clarified.
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Affiliation(s)
- Zhiming Ma
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Guang Shi
- Department of Oncology & Hematology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Xin Chen
- Department of Gastroenterology and Endoscopy Center, The Second Hospital of Jilin University, Changchun 130041, China
| | - Shutao Zhao
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun 130041, China
| | - Wei Ding
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Xudong Wang
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun 130041, China
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Robotic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. Surg Endosc 2019; 33:2357-2363. [DOI: 10.1007/s00464-019-06772-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/18/2019] [Indexed: 12/20/2022]
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Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer. Gastric Cancer 2017; 20:528-535. [PMID: 27379895 DOI: 10.1007/s10120-016-0624-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proximal gastrectomy has been introduced for early gastric cancer located in the upper third of the stomach, but expansion of its indication to advanced tumors has not been generally accepted in terms of lesser curvature lymph node dissection. METHODS We reviewed the medical records of 385 patients with tumors in the upper third of the stomach, and the incidence of metastasis and the therapeutic index related to the proximal (no. 3a) and distal (no. 3b) lymph nodes of the lesser curvature were analyzed and compared with those of tumors in the middle third (n = 1093) and lower third (n = 922) of the stomach. RESULTS The no. 3a rate of metastasis from advanced tumors in the upper third of the stomach was significantly higher than that from tumors in the middle third or lower third of the stomach. The no. 3b metastasis rate did not show any significant differences between the three locations, but the therapeutic index of no. 3b lymph nodes in the upper third of the stomach (1.7) was far lower than that in the middle third (7.1) or lower third (7.0). Further, the rate of metastasis from tumors with the distal border ending in the upper third of the stomach (2.2 %) was significantly (P < 0.0001) lower than that from tumors located in the upper third of the stomach but extending to the middle third (19.6 %), as well as from tumors located in middle third (17.1 %) or lower third (19.6 %), with the therapeutic index being only 1.1. The four no.-3b-positive tumors all measured more than 40 mm, and included one T3 tumor and three T4 tumors. CONCLUSION Proximal gastrectomy with exclusion of no. 3b lymphadenectomy could be indicated for at least T2 tumors measuring less than 40 mm localized in the upper third of the stomach.
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Lirosi MC, Biondi A, Ricci R. Surgical anatomy of gastric lymphatic drainage. Transl Gastroenterol Hepatol 2017; 2:14. [PMID: 28447049 DOI: 10.21037/tgh.2016.12.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/08/2016] [Indexed: 12/17/2022] Open
Abstract
The lymphatic system of the stomach is a multidirectional and complex network composed of lymphatic nodes and vessels. Lymph node metastasis is the most important prognostic factor in curable gastric cancer and lymph node dissection is one of the main areas of surgical research in gastric cancer. Therefore the anatomical classification and embryological development of the gastric lymphatic system have been well described in the literature. The current description of the gastric lymphatic system of the stomach has a surgical orientation and follows the recommendations of the Japanese Gastric Cancer Association. A thorough knowledge of the lymphatic system surrounding the stomach proves to be invaluable to surgeons treating patients with gastric cancer. The aim of this paper is to provide a concise review about surgical anatomy of the gastric lymphatic drainage.
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Affiliation(s)
- Maria Carmen Lirosi
- General Surgery Unit, Department of Surgery, "A. Gemelli" University Hospital Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Alberto Biondi
- General Surgery Unit, Department of Surgery, "A. Gemelli" University Hospital Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Ricci
- Department of Pathology, "A. Gemelli" University Hospital Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
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Sugita H, Oda E, Hirota M, Ishikawa S, Tomiyasu S, Tanaka H, Arita T, Yagi Y, Baba H. Significance of lymphadenectomy with splenectomy in radical surgery for advanced (pT3/pT4) remnant gastric cancer. Surgery 2016; 159:1082-9. [DOI: 10.1016/j.surg.2015.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/08/2015] [Accepted: 09/12/2015] [Indexed: 01/14/2023]
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17
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Prognostic significance of the recurrence pattern and risk factors for recurrence in patients with proximal gastric cancer who underwent curative gastrectomy. Tumour Biol 2015; 36:6191-9. [PMID: 25761877 DOI: 10.1007/s13277-015-3304-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/02/2015] [Indexed: 02/07/2023] Open
Abstract
Proximal gastric cancer has a high propensity of early recurrence after curative resection due to high incidence of lymph node involvement. In the present study, we aimed to investigate the pattern and time of recurrence and to evaluate the risk factors for recurrence of patients with proximal gastric cancer. Between 2005 and 2013, 99 patients with recurrent proximal gastric cancer who underwent radical gastrectomy were retrospectively analyzed. The prognostic significance of the pattern and the time of recurrence and the relationship between the pattern of recurrence and the other clinicopathological factors were evaluated. The median time to recurrence was 24 months; 45.5 % of patients relapsed within 2 years. Forty-three (43.4 %) patients indicated hematogenous recurrence and 41 (41.4 %) patients revealed peritoneal recurrence with the most predominant patterns. The median progression-free survival (PFS) time for patients with locoregional recurrence was significantly better than that of patients with peritoneal recurrences, hematogenous recurrences, and distant lymph nodes (32.2 vs. 18.9 vs. 18.2 vs. 9.7 months, p = 0.005, respectively). Moreover, the median overall survival (OS) interval for patients with distant lymph nodes recurrence was significantly worse than that of patients with locoregional, peritoneal, and hematogenous recurrences (13.5 vs. 48.5 vs. 31.4 vs. 29.9 months, p = 0.006, respectively). The presence of lymph node metastasis (p = 0.004) and surgery type (p = 0.04) for PFS and the time of recurrence (p = 0.033), lymph node metastasis (p = 0.03), and surgery type (p = 0.04) for OS were found to be independent prognostic factors by multivariate analysis. Logistic regression analysis indicated that the presence of lymph node metastasis and surgery type were independent risk factors for predicting the occurrence of early recurrence (p = 0.001, OR 0.48 and p = 0.028, OR 0.41, respectively). The median OS time of early recurrence patients was significantly shorter than that of patients with late recurrence (16.6 vs. 55.2 months, p < 0.001). Furthermore, proximal gastrectomy, poorly differentiated histology, advanced pT stage, and lymph node metastasis were significantly associated with early recurrence. Our results showed that lymph node metastasis and surgery type were independent risk factors for prediction of early recurrence in proximal gastric cancer. Thus, total gastrectomy with regional lymph node dissection may be a suitable treatment option for proximal gastric cancer patients with tumors that have high risk features for recurrence.
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18
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Yang K, Zhang WH, Chen XZ, Chen XL, Zhang B, Chen ZX, Zhou ZG, Hu JK. Survival benefit and safety of no. 10 lymphadenectomy for gastric cancer patients with total gastrectomy. Medicine (Baltimore) 2014; 93:e158. [PMID: 25437029 PMCID: PMC4616371 DOI: 10.1097/md.0000000000000158] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This study was aimed to evaluate the survival benefit and safety of No. 10 lymphadenectomy for gastric cancer patients with total gastrectomy.Splenic hilar lymph nodes (LNs) are required to be dissected in total gastrectomy with D2 lymphadenectomy. However, there has still not been a consensus in aspects of survival and safety on No. 10 LN resection.From January 2006 to December 2011, 453 patients undergoing total gastrectomy for gastric cancer were retrospectively analyzed. Patients were grouped according to No. 10 lymphadenectomy (10D+/10D-). Clinicopathologic characteristics were compared between the 2 groups. These patients had undergone a follow-up until January 2014. The overall survival, morbidity, and mortality rate were analyzed. Subgroup analyses which were stratified by the sex, age, tumor location, lymphadenectomy extent, curative degree, differentiation, tumor size, and TNM staging (ie, stages of tumor) were performed.There were 220 patients in 10D+ group, whereas 233 in 10D- group. In terms of prognosis, the baseline features between the 2 groups were almost comparable. The incidence of No. 10 LN metastasis was 11.82%. There was no difference in morbidity and mortality between the 2 groups. Significantly more LNs were harvested from patients in 10D+ group (P = 0.000). The estimated overall 5-year survival rates were 46.44% and 37.43% in 10D+ group and 10D- group respectively, which is not statistically significant (P = 0.3288). Although no statistical significance was found in the estimated 5-year survival rate, these data were obviously higher in patients with age >60 years, Siewert II/ III tumors, N1 status, or IIIa/IIIc stages when No. 10 lymphadenectomies were performed.Although the differences were obvious, the 5-year survival rates between the 2 groups did not reach statistical significances, which was probably caused by too small patient samples. High-quality studies with larger sample sizes are needed before stronger statement can be done. Until then, the No. 10 LNs' resection might be recommended in total gastrectomy with D2 lymphadenectomy with an acceptable incidence of complications.
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Affiliation(s)
- Kun Yang
- From the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China (KY, W-HZ, X-ZC, BZ, Z-XC, Z-GZ, J-KH)
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Chen XL, Yang K, Zhang WH, Chen XZ, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. Metastasis, risk factors and prognostic significance of splenic hilar lymph nodes in gastric adenocarcinoma. PLoS One 2014; 9:e99650. [PMID: 24915065 PMCID: PMC4051839 DOI: 10.1371/journal.pone.0099650] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/18/2014] [Indexed: 02/05/2023] Open
Abstract
Background The metastatic rate and risk factors of splenic hilar (No.10) lymph nodes (LNs) in gastric adenocarcinoma were still variable and uncertain, and the prognostic significance of No.10 LNs was also controversial. The aim of this retrospective study was to analyze the metastatic rate, risk factors and prognostic significance of No.10 LNs in gastric adenocarcinoma. Methods From August 2007 to December 2011, 205 patients who were diagnosed with primary gastric adenocarcinoma and underwent total or proximal gastrectomy plus No.10 LNs dissection in West China Hospital were enrolled. Clinicopathological features and survival outcomes were retrospectively analyzed. Results Mean numbers of harvested LNs and metastatic LNs were 34.8±12.6 (15–73) and 8.7±10.8 (0–67), respectively. The proportion of cases with positive No.10 LNs was 8.8% (18/205). In all 204 dissected No.10 LNs, 47 LNs (23.0%) were metastatic. In 52.2% (107/205) patients, the dissected splenic hilar tissues were histologically determined as only fat tissues but without LNs structure. Histological evidence of LNs structure was found in 98 (47.8%) patients with 18.4% (18/98) metastatic No.10 LNs. In multivariate logistic regression analysis, metastasis of No.10 LNs was significantly correlated with No.4sa LNs (p = 0.010) and pN stage (p = 0.012). Regarding survival analysis, 199 (97.1%) patients were followed up (0.6–74.8 months). In all patients with R0 resection, metastatic No.10 LNs caused significantly worse prognosis both in Kaplan-Meier (p = 0.006) and Cox regression analysis (p = 0.031). Conclusions Although the metastatic rate of No.10 LNs was 8.8%, dissection of No.10 LNs might be meaningful due to the poor prognosis of positive cases. And attentions should be also paid to its correlated factors including pN stage and No.4sa LNs.
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Affiliation(s)
- Xiao-Long Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sicuhan, China
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sicuhan, China
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sicuhan, China
| | - Xin-Zu Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sicuhan, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sicuhan, China
| | - Zhi-Xin Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sicuhan, China
| | - Jia-Ping Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sicuhan, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sicuhan, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sicuhan, China
- * E-mail:
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Li F, Zhang R, Liang H, Liu H, Quan J. The pattern and risk factors of recurrence of proximal gastric cancer after curative resection. J Surg Oncol 2012; 107:130-5. [PMID: 22949400 DOI: 10.1002/jso.23252] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/08/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE To explore the time and pattern of recurrence of proximal gastric cancer and estimate the risk factors and prognostic factors for it. Considering these risk factors, postoperative adjuvant therapies and follow-up program can be individualized. METHODS The data of 135 recurrence proximal gastric cancer patients were extracted and analyzed. RESULTS In 135 recurrence patients, the median time to recurrence was 14.0 months, 116 (85.9%) patients had recurrences within 2 years. Loco-regional recurrence was the most prevalent pattern. Hematogenous metastasis was next prevalent pattern in which the liver was the most common organ. Peritoneal recurrence occurred in 32 patients. Five patients recurred in distant lymph nodes. The deeper invasion was associated with higher incidence of hematogenous metastases and peritoneal recurrence. The histological type, depth of invasion, and lymph node metastasis were independent risk factors for overall recurrence. While, negative lymph nodes counts were another independent risk factors for early recurrence. Patients with systemic recurrence and early recurrence patients had poorer prognosis. CONCLUSION Total gastrectomy and adequate lymph nodes dissection were rational choice of proximal gastric cancer with deeper invasion. Pathologic predictors of invasion, histological type, lymph nodes metastasis and negative lymph node counts could guide individualized, risk-oriented adjuvant treatment, and follow-up plan.
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Affiliation(s)
- Fangxuan Li
- Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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The significance of splenectomy for advanced proximal gastric cancer. Int J Surg Oncol 2012; 2012:301530. [PMID: 22685639 PMCID: PMC3364576 DOI: 10.1155/2012/301530] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/11/2012] [Indexed: 12/19/2022] Open
Abstract
Objectives. The significance of splenectomy in advanced proximal gastric cancer is examined retrospectively. Methods. From 1994 to 2004, 505 patients with advanced proximal gastric cancer underwent curative total gastrectomy with preserving spleen (T) for 264 patients and total gastrectomy with splenectomy (ST) for 241 patients. Results. Patients who underwent splenectomy showed more advanced lesions. The metastatic rate of lymph node (LN) in the splenic hilus (No. 10) in ST was 18.3%. As for the incidence of surgical complications, there was not statistically difference except for pancreatic fistula. The index of estimated benefit of (No. 10) LN was 4.2, which was similar to that of (No. 9), (No. 11p), (No. 11d), and (No. 16) LNs. 5-year survival rate of (No. 10) positive group was 22.2%. 5-year survival rates of pSE and pN2 in T group were better than that of pSE and pN2 in ST, respectively. The superiority of ST was not confirmed even in Stage II, IIIA, and IIIB. Conclusion. Splenectomy was not effective for patients with (No. 10) metastasis in long-term survival. Spleen-preserving total gastrectomy will be feasible and be enough to accomplish radical surgery for locally advanced proximal gastric cancer.
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Kosuga T, Ichikawa D, Okamoto K, Komatsu S, Shiozaki A, Fujiwara H, Otsuji E. Survival benefits from splenic hilar lymph node dissection by splenectomy in gastric cancer patients: relative comparison of the benefits in subgroups of patients. Gastric Cancer 2011; 14:172-7. [PMID: 21331530 DOI: 10.1007/s10120-011-0028-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 12/27/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The present study estimated survival benefits from lymph node dissection at the splenic hilus in advanced proximal gastric cancer patients who underwent total gastrectomy with simultaneous splenectomy, and then determined patient subgroups that received relatively high survival benefits from splenectomy. METHODS A total of 280 patients with advanced proximal gastric cancer who underwent curative total gastrectomy with simultaneous splenectomy were retrospectively analyzed. Patients with primary tumors directly invading the spleen or pancreas and those with gross metastases to the para-aortic nodes, as determined by intraoperative diagnosis, were excluded from analyses. The index of estimated benefit from lymph node dissection at the splenic hilus by splenectomy was calculated for each clinicopathological factor by multiplying the incidence of splenic hilar metastasis by the 5-year survival rate of patients with metastasis to that nodal station. RESULTS Thirty patients (10.7%) showed lymph node metastasis at the splenic hilus, and the 5-year survival rate of these patients was 51.3% (overall index 5.49). The index was relatively high in patient subgroups with tumors localized on the greater curvature (19.4) and Borrmann type 4 cancers (12.9), while relatively low in subgroups with encircling tumors (1.62) and tumors invading adjacent organs other than the spleen and pancreas (0). CONCLUSION Patients with tumors localized on the greater curvature and Borrmann type 4 cancers might obtain relatively high survival benefits from lymph node dissection at the splenic hilus by splenectomy.
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Affiliation(s)
- Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
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