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The Influence of Group No.8p Lymph Node Dissection on the Prognosis of Advanced Gastric Cancer. J Gastrointest Surg 2023; 27:887-894. [PMID: 36750543 DOI: 10.1007/s11605-023-05599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/19/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Controversy over whether No.8p lymph nodes (LNs) involvement is distant or regional metastasis remains, and the possible inclusion of No.8p LNs in D2 lymphadenectomy is unclear. AIM This work aimed to investigate the effect of No.8p LN dissection on the prognosis of patients with different LN metastases in advanced gastric cancer (GC). METHODS A retrospective case-control study was used to collect 1149 cases of radical gastrectomy from July 2003 to April 2013. The patients were divided into the No.8a group (303 cases) and the No.8a + 8p group (846 cases) according to whether No.8p LN dissection was performed. The effect of No.8p LN dissection on the prognosis of patients with different total number of LN metastasis was analyzed. RESULTS Both No.8p positive and No.8p dissection were independent prognostic factors in patients with advanced GC. The 5-year overall survival rate (OS) of the positive No.8p group was 13.0%, and that of the negative No.8p group was 66.6%; the difference was significant (P < 0.05). In the group where the total number of LN metastasis was 3-15, the OS of patients with positive No.8p was significantly lower than that of the negative group (P < 0.05). The 5-year OS of the No.8a + 8p dissection group was 65.4%, and that of the No.8a dissection group was 55.5%; the difference was significant (P < 0.05). In the group where the total number of LN metastasis was 0-2, the No.8a + 8p dissection group had significantly higher OS than the No.8a dissection group (P < 0.05). CONCLUSION For patients with advanced GC, No.8p LN metastasis indicates a poor prognosis. LN dissection in the No.8a + 8p group may further improve the prognosis of some patients, especially when the total number of LN metastasis is 0-2.
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Zhang YJ, Xiang RC, Li J, Liu Y, Xie SM, An L, Li HL, Mai G. Superior pancreatic lymphadenectomy with portal vein priority via posterior common hepatic artery approach in laparoscopic radical gastrectomy. World J Clin Cases 2022; 10:1834-1842. [PMID: 35317149 PMCID: PMC8891763 DOI: 10.12998/wjcc.v10.i6.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/16/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND D2 lymph node dissection for advanced gastric cancer is advocated, and station 8p lymph node should be considered in selected patients, which is, however, technically difficult.
AIM To introduce a new and easy-to-perform procedure for dissection of the lymph nodes superior to the pancreas.
METHODS A series of patients who underwent laparoscopic gastrectomy for gastric cancer were retrospectively included with utilization of a new procedure for superior pancreatic lymphadenectomy (LND) with portal vein priority via the posterior common hepatic artery approach (SPLD-PPPH) based on a newly defined portal triangle. The surgical outcome of the patients, as well as the efficacy and safety of SPLD-PPPH are reported.
RESULTS A total of 51 patients were included with most of them being male (n = 34, 66.7%). According to the 8th edition of AJCC TNM staging, there were four (7.8%) patients in stage I, 13 (25.5%) in stage II, 33 (64.7%) in stage III and one (2.0%) in stage IV. The average duration for LND was about 1 h (67.7 ± 6.9 min). After surgery, four patients developed morbidities, but all were treated successfully with no perioperative mortality. Among the 51 patients included, the percentage of patients who had lymph node metastasis at station 8p was 9.8%. Of note, with a total of 14 lymph nodes harvested at station 8p, the incidence of nodal metastasis was 14.3%.
CONCLUSION About one in 10 patients with advanced gastric cancer had nodal metastasis at station 8p. The new approach of SPLD-PPPH is safe and effective for D2+ LND during laparoscopic radical gastrectomy.
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Affiliation(s)
- Yu-Jia Zhang
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Rong-Chao Xiang
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Jun Li
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Yong Liu
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Si-Ming Xie
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Liang An
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Hua-Lin Li
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Gang Mai
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
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Dai W, Zhai ET, Chen J, Chen Z, Zhao R, Chen C, Yuan Y, Wu H, Cai S, He Y. Extensive Dissection at No. 12 Station During D2 Lymphadenectomy Improves Survival for Advanced Lower-Third Gastric Cancer: A Retrospective Study From a Single Center in Southern China. Front Oncol 2022; 11:760963. [PMID: 35087750 PMCID: PMC8787051 DOI: 10.3389/fonc.2021.760963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/14/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND D2 lymphadenectomy including No. 12a dissection has been accepted as a standard surgical management of advanced lower-third gastric cancer (GC). The necessity of extensive No. 12 nodes (No. 12a, 12b, and 12p) dissection remains controversial. This study aims to explore its impact on long-term survival for resectable GC. METHODS From 2009 to 2016, 353 advanced lower-third GC patients undergoing at least D2 lymphadenectomy during a radical surgery were included, with 179 patients receiving No. 12a, 12b, and 12p dissection as study group. A total of 174 patients with No. 12a dissection were employed as control group. Surgical and long-term outcomes including 90-day complications incidence, therapeutic value index (TVI), 3-year progression-free survival (PFS), and 5-year overall survival (OS) were compared between both groups. RESULTS No. 12 lymph node metastasis was observed in 20 (5.7%) patients, with 10 cases in each group (5.6% vs. 5.7%, p = 0.948). The metastatic rates at No. 12a, 12b, and 12p were 5.7%, 2.2%, and 1.7%, respectively. The incidence of 90-day complications was identical between both groups. Extensive No. 12 dissection was associated with increased TVI at No. 12 station (3.9 vs. 0.6), prolonged 3-year PFS rate (67.0% vs. 55.9%, p = 0.045) and 5-year OS rate (66.2% vs. 54.0%, p = 0.027). The further Cox-regression analysis showed that the 12abp dissection was an independent prognostic factor of improved survival (p = 0.026). CONCLUSION Adding No. 12b and 12p lymph nodes to D2 lymphadenectomy might be effective in surgical treatment of advanced lower-third GC and improve oncological outcomes compared with No. 12a-based D2 lymphadenectomy.
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Affiliation(s)
- Weigang Dai
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Er-Tao Zhai
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Jianhui Chen
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Zhihui Chen
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Risheng Zhao
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Chuangqi Chen
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Yujie Yuan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Hui Wu
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Shirong Cai
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Yulong He
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
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Li JQ, He D, Liang YX. Current status of extended 'D2 plus' lymphadenectomy in advanced gastric cancer. Oncol Lett 2021; 21:467. [PMID: 33907577 PMCID: PMC8063322 DOI: 10.3892/ol.2021.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/18/2021] [Indexed: 11/06/2022] Open
Abstract
The extent of lymph node (LN) dissection has been a topic of interest in gastric cancer (GC) surgery. D2 lymphadenectomy is considered the standard surgical procedure for most resectable advanced GC cases. The value and indications of more extended lymphadenectomy than D2 remain unclear. Currently, the controversial stations beyond the D2 range are mainly focused on no. 14v, no. 16a2/b1 and no. 13 LN stations. The metastatic rate of no. 14v LN is relatively high in advanced distal GC, particularly in patients with suspicious no. 6 LN metastasis. D2 plus no. 14v LN dissection may be attributed to improved survival outcomes for patients with obvious no. 6 LN metastasis. Although GC with para-aortic lymph node (PALN) metastases is considered an M1 disease beyond surgical cure, patients with limited PALN metastases may benefit from the treatment strategy of adjuvant chemotherapy followed by D2 plus no. 16a2-b1 LN dissection. In addition, D2 plus no. 13 LN dissection may be an option in a potentially curative gastrectomy for GC with duodenal invasion. The present review discusses the current status and future perspectives of D2 plus lymphadenectomy.
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Affiliation(s)
- Jing-Quan Li
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, P.R. China
| | - Donglei He
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, P.R. China
| | - Yue-Xiang Liang
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, P.R. China
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Abstract
Gastrectomy with lymph node (LN) dissection has been regarded as the standard surgery for gastric cancer (GC), however, the rational extent of lymphadenectomy remains controversial. Though gastrectomy with extended lymphadenectomy beyond D2 is classified as a non-standard gastrectomy, its clinical significance has been evaluated in many studies. Although hard evidence is lacking, D2 plus superior mesenteric vein (No. 14v) LN dissection is recommended when harbor metastasis to No. 6 nodes is suspected in the lower stomach, and dissection of splenic hilar (No. 10) LN can be performed for advanced GC invading the greater curvature of the upper stomach, and D2 plus posterior surface of the pancreatic head (No. 13) LN dissection may be an option in a potentially curative gastrectomy for cancer invading the duodenum. Prophylactic D2+ para-aortic nodal dissection (PAND) was not routinely recommended for advanced GC patients, but therapeutic D2 plus PAND may offer a chance of cure in selected patients, preoperative chemotherapy was considered as the standard treatment for GC with para-aortic node metastasis. There has been no consensus on the extent of lymphadenectomy for the adenocarcinoma of the esophagogastric junction (AEG) so far. The length of esophageal invasion can be used as a reference point for mediastinal LN metastases, and the distance from the esophagogastric junction to the distal end of the tumor is essential for determining the optimal extent of resection. The quality of lymphadenectomy may influence prognosis in GC patients. Both hospital volume and surgeon volume were important factors for the quality of radical gastrectomy. Centralization of GC surgery may be needed to improve prognosis.
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Affiliation(s)
- Bin Ke
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Han Liang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, China
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Sun W, Deng J, Zhang N, Liu H, Liu J, Gu P, Du Y, Wu Z, He W, Wang P, Liang H. Prognostic impact of D2-plus lymphadenectomy and optimal extent of lymphadenectomy in advanced gastric antral carcinoma: Propensity score matching analysis. Chin J Cancer Res 2020; 32:51-61. [PMID: 32194305 PMCID: PMC7072021 DOI: 10.21147/j.issn.1000-9604.2020.01.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate the prognostic impact of D2-plus lymphadenectomy including the posterior (No. 8p, No. 12b/p, No. 13, and No. 14v), and para-aortic (No. 16a2, and No. 16b1) lymph nodes (LNs) in subtotal gastrectomy for advanced gastric antral carcinoma. Methods A total of 203 patients with advanced gastric cancer (GC) located in the antrum, who underwent R0 gastrectomy with D2 or D2-plus lymphadenectomy between January 2003 and December 2011 were enrolled. Propensity score matching was used to reduce the strength of the confounding factors to accurately evaluate prognoses. The therapeutic value index (TVI) was calculate to evaluate the survival benefit of dissecting each LN station. Results Of 102 patients with D2-plus lymphadenectomy, 21 (20.59%) were pathologically identified as having LN metastases beyond the extent of D2 lymphadenectomy. After matching, the overall survival (OS) was significantly better in the D2-plus than the D2 group (P=0.030). In the multivariate survival analysis, D2-plus lymphadenectomy (hazard ratio, 0.516; P=0.006) was confirmed to significantly improve the survival rate. In the logistic regression analysis, pN stage [odds ratio (OR), 2.533; 95% confidence interval (95% CI), 1.368−4.691; P=0.003] and extent of LNs metastasis (OR, 5.965; 95% CI, 1.335−26.650; P=0.019) were identified as independent risk factors for LN metastases beyond the extent of D2 lymphadenectomy. The TVI of patient with metastasis to LNs station was 7.1 (No. 8p), 5.7 (No. 12p), 5.1 (No. 13), and 7.1 (both No. 16a2 and No. 16b1), respectively. Conclusions D2-plus lymphadenectomy may improve the prognoses of some patients with advanced GC located in the antrum, especially for No. 8p, No. 12b, No. 13, and No. 16.
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Affiliation(s)
- Weilin Sun
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jingyu Deng
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Nannan Zhang
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Huifang Liu
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jinyuan Liu
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Pengfei Gu
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yingxin Du
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zizhen Wu
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Wenting He
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Pengliang Wang
- Affiliated Cancer Hospital & Institution of Guangzhou Medical University, Guangzhou 510095, China
| | - Han Liang
- Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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Han WH, Joo J, Eom BW, Ryu KW, Kim YW, Kook MC, Yoon HM. Factors associated with metastasis in superior mesenteric vein lymph node in subtotal gastrectomy for gastric cancer: Retrospective case control study. Chin J Cancer Res 2020; 32:43-50. [PMID: 32194304 PMCID: PMC7072010 DOI: 10.21147/j.issn.1000-9604.2020.01.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective The revised Japanese treatment guideline for gastric cancer recommends dissection of the superior mesenteric vein lymph node (No. 14v LN) if there is metastasis in infrapyloric lymph node (No. 6 LN). However, it is still controversial whether LN dissection is necessary. The aim of this study was to investigate the factors associated with metastasis in No. 14v LN. Methods Patients who underwent D2 lymphadenectomy between 2003 and 2010 were included. We excluded patients who underwent total gastrectomy, had multiple lesions, or had missing data about the status of metastasis in the LNs that were included in D2 lymphadenectomy. Clinicopathologic characteristics and the metastasis in regional LNs were compared between patients with No. 14v LN metastasis (14v+) and those without (14v−). Results Five hundred sixty patients were included in this study. Univariate analysis showed that old age, larger tumor size, tumor location, differentiation, lymphatic invasion, venous invasion, perineural invasion, T classification, and N classification were related to metastasis in No. 14v LN. Multivariate analysis showed differentiation (P=0.027) and N classification (P<0.001) were independent related factors. Metastasis in infrapyloric lymph node (No. 6 LN) and proxiaml splenic lymph node (No. 11p LN) was independently associated with metastasis in No. 14v LN. Conclusions Differentiation and N classification were independent factors associated with No. 14v LN metastasis, and No. 6 and No. 11p LN metastasis were independent risk factors for No. 14v LN metastasis.
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Affiliation(s)
- Won Ho Han
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Jungnam Joo
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Myeong-Cherl Kook
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
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Liang Y, Cui J, Cai Y, Liu L, Zhou J, Li Q, Wu J, He D. "D2 plus" lymphadenectomy is associated with improved survival in distal gastric cancer with clinical serosa invasion: a propensity score analysis. Sci Rep 2019; 9:19186. [PMID: 31844139 PMCID: PMC6914783 DOI: 10.1038/s41598-019-55535-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/30/2019] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to elucidate the potential impact of “D2 plus” lymphadenectomy on the long-term survival of distal gastric cancer (GC) patients with clinical serosa invasion. A total of 394 distal GC patients with clinical serosa invasion who underwent at least standard D2 lymphadenectomy were enrolled. Patients were categorized into two groups according to the extent of lymphadenectomy: D2 group and “D2 plus” group. Propensity score matching was used to adjust for the differences in baseline characteristics. In the multivariate analysis for the whole study series, extent of lymphadenectomy was an independent prognostic factor for GC patients (P = 0.011). With the strata analysis, the significant prognostic differences between the two groups were only observed in patients at the IIIa-b or N1-3a stages. After matching, patients in “D2 plus” group still demonstrated a significantly higher 5-year overall survival rate than those in D2 group (55.3% versus 43.9%, P = 0.042). The common therapeutic value index of No. 12b, No. 12p, No. 14v and No. 13 LNs was 4.6, which was close to that of No. 5 LN station. In conclusion, “D2 plus” lymphadenectomy may be associated with improved overall survival in distal GC with clinical serosa invasion.
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Affiliation(s)
- Yuexiang Liang
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Jingli Cui
- Department of general surgery, Weifang People's Hospital, Guangwen street, Kuiwen District, Weifang City, 261000, Shandong Province, China
| | - Yaoqing Cai
- Department of gastrointestinal surgery, Hainan Cancer Hospital, Changbinxi Road, Xiuying District, Haikou City, 570102, Hainan Province, China
| | - Lijie Liu
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Jianghao Zhou
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Qiang Li
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Junmei Wu
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Donglei He
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China.
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Xu ZY, Hu C, Chen S, Du YA, Huang L, Yu PF, Wang LJ, Cheng XD. Evaluation of D2-plus radical resection for gastric cancer with pyloric invasion. BMC Surg 2019; 19:172. [PMID: 31747885 PMCID: PMC6868836 DOI: 10.1186/s12893-019-0605-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022] Open
Abstract
Background The optimal lymphadenectomy for gastric cancer (GC) with pyloric invasion is controversial because the pattern of lymph node metastasis is different from that of distal GC. The rate of lymph node metastasis into the posterior area of the pancreatic head and hepatoduodenal ligament is high. This study evaluated the estimated benefit of radical gastrectomy with D2-plus lymphadenectomy in patients with pyloric invasion. Methods All patients with GC invading the pylorus who underwent curative surgical resection with D2-plus lymphadenectomy between February 2013 and September 2015 were enrolled in the study. The index of estimated benefit from lymph node dissection (IEBLD) was calculated by multiplying the incidence of metastasis to each lymph node station by the 3-year overall survival (OS) rate of patients with metastasis to that station. Results In total, 128 patients were eligible. The rate of lymph node metastasis and the 3-year OS rate (and IEBLD) of the patients with metastasis to lymph nodes were 14.3 and 44.4% (5.56) for No. 8p, 10.9 and 35.7% (3.89) for No. 12b, 9.5 and 33.3% (3.13) for No. 12p, 18.8 and 54.2% (10.19) for No. 13, and 21.8 and 53.6% (11.68) for No. 14v, respectively. Conclusions In radical gastrectomy for GC with pyloric invasion, some survival benefit was observed with dissection of the No. 13 and No. 14 lymph nodes, but there was no survival benefit with dissection of the No. 8p lymph nodes. The No. 12b and No. 12p lymph nodes may be better to dissect in cT3 GC patients with pyloric invasion. Trial registration http://ClinicalTrials.gov Identifier: NCT01836991. Date of registration: April 17, 2013.
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Affiliation(s)
- Zhi-Yuan Xu
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
| | - Can Hu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Shangqi Chen
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Yi-An Du
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
| | - Ling Huang
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
| | - Peng-Fei Yu
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
| | - Li-Jing Wang
- Department of Ultrasonics, The Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
| | - Xiang-Dong Cheng
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China.
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10
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Zheng C, Gao ZM, Sun AQ, Huang HB, Wang ZN, Li K, Gao S. Prognostic significance of 14v-lymph node dissection to D2 dissection for lower-third gastric cancer. World J Clin Cases 2019; 7:2712-2721. [PMID: 31616687 PMCID: PMC6789393 DOI: 10.12998/wjcc.v7.i18.2712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/06/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Radical gastrectomy with D2 lymph node (LN) dissection is the standard surgical procedure for patients with resectable gastric cancer (GC). In the fifteenth edition of the Japanese Classification of Gastric Carcinoma, the 14v LN (LNs along the root of the superior mesenteric vein) was defined as the regional gastric LN. The efficacy of 14v LN dissection during radical distal gastrectomy for lower-third GC remains controversial.
AIM To analyze whether the addition of 14v LN dissection improved the survival of patients with lower-third GC.
METHODS The data from 65 patients who underwent 14v LN dissection and 65 patients treated without 14v LN dissection were selected using the propensity score-matched method from our institute database constructed between 2000 and 2012. Overall survival was compared between the groups.
RESULTS Overall survival was similar between patients with 14v LN metastasis and those with distant metastasis (P = 0.521). Among patients with pathological stage IIIA disease, those who were treated with 14v LN dissection had a significantly higher overall survival than those treated without it (P = 0.020). Multivariate analysis showed that age < 65 years and pT2-3 stage were independent favorable prognostic factors for prolonged overall survival in patients with pathological stage IIIA disease. Patients with No. 1, No. 6, No. 8a, or No. 11p LN metastasis were at higher risk of having 14v LN metastasis.
CONCLUSION Adding 14v LN dissection to D2 dissection during radical distal gastrectomy may improve the overall survival of patients with pathological stage IIIA lower-third GC.
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Affiliation(s)
- Chen Zheng
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zi-Ming Gao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - An-Qi Sun
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Hai-Bo Huang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhen-Ning Wang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Kai Li
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Shan Gao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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11
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Yu P, Du Y, Xu Z, Huang L, Cheng X. Comparison of D2 and D2 plus radical surgery for advanced distal gastric cancer: a randomized controlled study. World J Surg Oncol 2019; 17:28. [PMID: 30728027 PMCID: PMC6366021 DOI: 10.1186/s12957-019-1572-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/27/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The optimal extent of lymph node (LN) dissection for advanced distal gastric cancer remains controversial. The present study compared the safety and efficacy of extended LN dissection (D2 plus) with standard D2 radical surgery for advanced distal gastric cancer. METHODS Eligible patients were enrolled and randomly assigned into two groups: D2 group and D2 plus group. Patients in the D2 group received standard D2 LN dissection, while patients in the D2 plus group received an additional nos. 8p, 12b, 13, and 14v LNs dissection. The clinicopathological and surgical data of these two groups were compared, and the factors that may influence survival were analyzed. RESULTS Seventy patients were enrolled, out of which 64 patients were analyzed. There were no significant differences in the operative time, blood loss, and complications between the two groups. In the D2 plus group, the positive rate of the nos. 12b, 13, and 14v LN was 3.1%, 9.4%, and 12.5%, respectively. The positive rate of the no. 13 LN correlated with the duodenal involvement, while the positive rate of the no. 14v LN correlated with no. 6 LN metastasis. The survival analysis indicated that among patients with duodenum involvement, the 3-year disease-free survival rate of the D2 plus group was significantly better than that of the D2 group. CONCLUSION Duodenum involvement and positive no. 6 LN were high-risk factors of advanced distal gastric cancer. D2 plus radical surgery turned out to be safe and feasible, and may improve the prognosis of these patients. However, further clinical trials are still warranted. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov as NCT01836991 , registered on 22 April 2013.
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Affiliation(s)
- Pengfei Yu
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Yian Du
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Zhiyuan Xu
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Ling Huang
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Xiangdong Cheng
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
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12
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Mengardo V, Bencivenga M, Weindelmayer J, Pavarana M, Giacopuzzi S, de Manzoni G. Para-aortic lymphadenectomy in surgery for gastric cancer: current indications and future perspectives. Updates Surg 2018; 70:207-211. [PMID: 29846892 DOI: 10.1007/s13304-018-0549-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/13/2018] [Indexed: 12/20/2022]
Abstract
Involvement of para-aortic nodes (PAN) has been detected at pathological examination in 10-25% of locally advanced gastric cancer. Based on these data of nodal diffusion, the lymphadenectomy of para-aortic stations would be desirable in locally advanced gastric cancer. However, the debate on the oncological benefit of para-aortic nodes dissection is still not solved. A review of the literature was performed and papers reporting either the rate of para-aortic nodal metastases or the long-term survival outcomes after D2+ para-aortic nodes dissection (PAND) or D3 lymphadenectomy were descriptively reported. The literature survey yielded 14 studies. Most of the papers show the outcome of series of advanced gastric cancer treated with surgery alone, while starting from 2012, 3 articles report the outcomes of D2 + PAND or D3 lymphadenectomy after preoperative chemotherapy. The rate of PAN metastases ranges between 8.5 and 28% in surgical series. Survival outcomes largely improved in series of patients treated with multimodal approach compared to those of surgery alone. In patients with clinically detected para-aortic nodal metastases, preoperative chemotherapy followed by PAND is indicated. More data are needed to clarify the indication to prophylactic PAND in the era of multimodal treatment, anyway super-extended lymphadenectomies have to be performed by experienced surgeons in dedicated centres.
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Affiliation(s)
- Valentina Mengardo
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| | - Maria Bencivenga
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Jacopo Weindelmayer
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Michele Pavarana
- Department of Medical Oncology, Ospedale Civile Maggiore of Verona, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Giovanni de Manzoni
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
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13
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Zhang J, Yuan Y, Wei Z, Ren J, Hou X, Yang D, Cai S, Chen C, Tan M, Chen GG, Wu K, He Y. Crosstalk between prognostic long noncoding RNAs and messenger RNAs as transcriptional hallmarks in gastric cancer. Epigenomics 2018; 10:433-443. [PMID: 29402138 DOI: 10.2217/epi-2017-0136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM Our study investigated the significance of the crosstalk between long noncoding RNAs (lncRNAs) and mRNAs in gastric cancer (GC). METHODS lncRNA and mRNA expression profiling data in 671 GC tumors and 77 nontumorous gastric tissues were retrieved from the gene expression omnibus database: GSE54129, GSE13911, GSE19826, GSE79973, GSE15459 and GSE66229. Differentially expressed analysis, RNA coexpression network construction, gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) enrichment analyses were conducted in this study. RESULTS Using differentially expressed and prognostic lncRNAs or mRNAs in GC, we constructed the lncRNA-mRNA coexpression networks. This network involved with vital GO and KEGG pathways. CONCLUSION Our study reveals coexpressed lncRNAs and mRNAs as transcriptional hallmarks in GC patients which provide interesting information regarding the incidence and outcome of GC.
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Affiliation(s)
- Jian Zhang
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yujie Yuan
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Zhewei Wei
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Jianwei Ren
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, PR China.,Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, PR China
| | - Xun Hou
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Dongjie Yang
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Sirong Cai
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Chuangqi Chen
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Min Tan
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - George Gong Chen
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, PR China.,Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, PR China
| | - Kaiming Wu
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yulong He
- Division of Gastrointestinal Surgery & Gastric Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
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