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Vu Tuan Anh N, Dang QT, Lam Vuong N, Nguyen VH, Ho LMQ, Tran QD, Dang TT, Tran AM, Doan TN, Nguyen HB, Nguyen TT, Duy Vo L. Regional Lymph Node Metastasis Distribution in Resectable Middle-Third Gastric Cancer: A Cross-Sectional Study. Cureus 2023; 15:e41236. [PMID: 37397656 PMCID: PMC10313942 DOI: 10.7759/cureus.41236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Lymph node (LN) metastasis happens even in early gastric cancer (GC) even in LN stations that are not adjacent to the primary tumor. Total or subtotal gastrectomy (TG or sTG) can be performed in the middle third of the GC if the negative proximal margin is maintained. These procedures differed in the extent of LN dissection; therefore, oncology considerations must be taken into consideration when selecting the appropriate procedure. Methods This was a cross-sectional study involving 98 patients suffering from middle-third GC. The metastatic lymph nodes (mLN) ratio was calculated in each case by the ratio between the number of mLN and the number of total LNs retrieved. We compare the difference in the total LN retrieved, number of mLN, and rate of positive LN (N+) between the two groups TG and sTG. Results The majority of patients had advanced GC (82.7% pT2-4). About 65.3% of patients had metastasis LN. The events of LN metastasis and skipped LN metastasis happened even in tumors contained in the submucosal layer. The metastasis rates in each LN station were also increasing in correlation with the depth of tumor invasion. For LN station No. 2, 4sa, 10, 11d (which are not mandatory) in sTG, the rate of mLN was 0% for the pT1-3 tumor, regardless of tumor longitudinal location. The rate of mLN for each station was higher in adjacent stations of the tumor (No. 1-3-5-7 in lesser curvature, No. 4sb-4d-6 in greater curvature, No.1-3-4sb in the anterior wall, No. 3-7-12a in the posterior wall). The total LN retrieved, number of mLN, and rate of positive LN were statistically higher in the TG group compared to the sTG group. However, the mean mLN ratios between the two groups were comparable (p = 0.116). Conclusion In accordance with the macroscopic and microscopic characteristics, we observed a stratified distribution of mLN in the middle third of the GC. With these early results, sTG combined with standard lymphadenectomy was an acceptable treatment for T1-T3 middle-third GC in terms of mLN distribution. Total No. 4sb LN dissection might also be reserved in gastrectomy for T1-T3 GC.
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Affiliation(s)
- Nguyen Vu Tuan Anh
- General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Quang Thong Dang
- Gastrointestinal Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Nguyen Lam Vuong
- Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Viet Hai Nguyen
- Gastrointestinal Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Le Minh Quoc Ho
- Gastrointestinal Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Quang Dat Tran
- Gastrointestinal Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Truong Thai Dang
- General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Anh Minh Tran
- Gastrointestinal Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Thuy Nguyen Doan
- Gastrointestinal Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Hoang Bac Nguyen
- General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Trung Tin Nguyen
- General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Long Duy Vo
- Gastrointestinal Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, VNM
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Du J, Shen Y, Yan W, Wang J. Risk factors of lymph node metastasis in the splenic hilum of gastric cancer patients: a meta-analysis. World J Surg Oncol 2020; 18:233. [PMID: 32873315 PMCID: PMC7466798 DOI: 10.1186/s12957-020-02008-1] [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: 06/19/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The issue of whether or not splenic hilum lymph nodes (SHLN) should be excised in radical gastrectomy with D2 lymph node dissection remains controversial. In this study, we identified the clinicopathological features in patients with gastric cancer that could serve as predictive risk factors of SHLN metastasis. METHODS We searched Medline, Embase, PubMed, and Web of Science databases from inception to May 2020 and consulted the related references. Overall, 15 articles evaluating a total of 4377 patients were included for study. The odds ratios (OR) of each risk factor and corresponding 95% confidence intervals (CI) were determined using the Revman 5.3 software. RESULTS Our meta-analysis revealed tumor size greater than 5 cm (p < 0.01), tumor localization in the greater curvature (p < 0.01), diffuse type (Lauren's classification) (p < 0.01), Borrmann types 3-4 (p < 0.01), poor differentiation and undifferentiation (p < 0.01), depth of invasion T3-T4 (p < 0.01), number of lymph node metastases N2-N3 (p < 0.01), distant metastasis M1 (p < 0.01), TNM stages 3-4 (p < 0.01), vascular invasion (p = 0.01), and lymphatic invasion (p < 0.01) as potential risk factors of SHLN metastasis. Moreover, positivity of Nos. 1, 2, 3, 4sa, 4sb, 4d, 6, 7, 9, 11, and 16 lymph nodes for metastasis was strongly associated with SHLN metastasis. CONCLUSIONS Tumor size, tumor location, Lauren's diffuse type, Borrmann type, degree of differentiation, T stage, N stage, M stage, TNM stage, vascular invasion, lymphatic infiltration, and other positive lymph nodes are risk factors for SHLN metastasis.
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Affiliation(s)
- Jun Du
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, China
| | - Yangchao Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, China
| | - Wenwu Yan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, China
| | - Jinguo Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, China.
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Zheng G, Liu J, Guo Y, Wang F, Liu S, Xu G, Guo M, Lian X, Zhang H, Feng F. Necessity of prophylactic splenic hilum lymph node clearance for middle and upper third gastric cancer: a network meta-analysis. BMC Cancer 2020; 20:149. [PMID: 32093683 PMCID: PMC7041100 DOI: 10.1186/s12885-020-6619-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/11/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND It remains controversial whether prophylactic No.10 lymph node clearance is necessary for gastric cancer. Thus, the present study aims to investigate the impact of prophylactic No.10 lymph node clearance on the perioperative complications and prognosis of upper and middle third gastric cancer. METHODS A network meta-analysis to identify both direct and indirect evidence with respect to the comparison of gastrectomy alone (G-A), gastrectomy combination with splenectomy (G + S) and gastrectomy combination with spleen-preserving splenic hilar dissection (G + SPSHD) was conducted. We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies published before September 2018. Perioperative complications and overall survival were analyzed. Hazard ratios (HR) were extracted from the publications on the basis of reported values or were extracted from survival curves by established methods. RESULTS Ten retrospective studies involving 2565 patients were included. In the direct comparison analyses, G-A showed comparable 5-year overall survival rate (HR: 1.1, 95%CI: 0.97-1.3) but lower total complication rate (OR: 0.37, 95%CI: 0.17-0.77) compared with G + S. Similarly, the 5-year overall survival rate between G + SPSHD and G + S was comparable (HR: 1.1, 95%CI: 0.92-1.4), while the total complication rate of G + SPSHD was lower than that of G + S (OR: 0.50, 95%CI: 0.28-0.88). In the indirect comparison analyses, both the 5-year overall survival rate (HR: 1.0, 95%CI: 0.78-1.3) and total complication rate (OR: 0.75, 95%CI: 0.29-1.9) were comparable between G-A and G + SPSHD. CONCLUSIONS Prophylactic No.10 lymph node clearance was not recommended for treatment of upper and middle third gastric cancer.
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Affiliation(s)
- Gaozan Zheng
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Jinqiang Liu
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
- Cadre' s sanitarium, 62101 Army of PLA, 67 Nahu Road, Xinyang, 464000, Henan, China
| | - Yinghao Guo
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
- Health company, 92667 Army of PLA, 39 East Zaoshan Road, Qingdao, 266100, Shandong, China
| | - Fei Wang
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
- Department of General Surgery, No. 534 Hospital of PLA, West Lichun Road, Luoyang, 471000, Henan, China
| | - Shushang Liu
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Guanghui Xu
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Man Guo
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Xiao Lian
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Hongwei Zhang
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China.
| | - Fan Feng
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China.
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Ding P, Gao Z, Zheng C, Chen J, Li K, Gao S. Risk evaluation of splenic hilar or splenic artery lymph node metastasis and survival analysis for patients with proximal gastric cancer after curative gastrectomy: a retrospective study. BMC Cancer 2019; 19:905. [PMID: 31510966 PMCID: PMC6737705 DOI: 10.1186/s12885-019-6112-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 08/30/2019] [Indexed: 12/16/2022] Open
Abstract
Background As splenectomy and spleen-preserving lymphadenectomy are performed only in some proximal gastric cancer patients, it is difficult to identify patients who have undergone radical gastrectomy with or without splenic hilar (No.10) or splenic artery (No.11) lymph node metastases. We aimed to determine the risk factors for No.10 and No.11 lymph node metastases and evaluate the survival significance of No.10 and No.11 lymph node dissection in advanced proximal gastric cancer patients. Methods A total of 873 advanced proximal gastric cancer patients who underwent curative gastrectomy with or without splenectomy or pancreaticosplenectomy were analyzed retrospectively. The clinicopathological characteristics of 152 patients who underwent splenectomy or pancreaticosplenectomy were analyzed to determine the risk factors for No.10 and No.11 lymph node metastases. The survival difference between patients with No.10 and No.11 lymph node dissections and those who did not undergo these dissections were compared. Results Patients with No.10 and No.11 lymph node metastases had very poor prognoses. Tumor invasion of the greater curvature and No.2 and No.4 lymph node metastases were independent risk factors for No.10 and No.11 lymph node metastases. No survival differences were evident between patients with No.10 and No.11 lymph node metastases who underwent No.10 and No.11 lymph node dissections and those who did not undergo these dissections but were at high risks of No.10 and No.11 lymph node metastases. Conclusions Splenic hilar or splenic artery lymph node dissection was not associated with increased survival, in proximal gastric cancer patients without direct cancer invasion of the spleen and pancreas, regardless of whether splenectomy, pancreaticosplenectomy, or spleen-preserving lymphadenectomy was performed.
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Affiliation(s)
- Peng Ding
- Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Ziming Gao
- Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Chen Zheng
- Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Junqing Chen
- Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Kai Li
- Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Shan Gao
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Sanhao Street 36, Shenyang, 110001, China.
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Guo X, Peng Z, Lv X, Cui J, Zhang K, Li J, Jin N, Xi H, Wei B, Chen L. Randomized controlled trial comparing short‐term outcomes of laparoscopic and open spleen‐preserving splenic hilar lymphadenectomy for advanced proximal gastric cancer: An interim report. J Surg Oncol 2018; 118:1264-1270. [PMID: 30380145 DOI: 10.1002/jso.25262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 09/08/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Xin Guo
- Department of General SurgeryChinese PLA General Hospital China
- Department of Endoscopic SurgeryChinese PLA 451st Hospital China
| | - Zheng Peng
- Department of General SurgeryChinese PLA General Hospital China
| | - Xiaohui Lv
- Department of Gynecology and ObstetricsXijing Hospital, The Fourth Military Medical University China
| | - Jianxin Cui
- Department of General SurgeryChinese PLA General Hospital China
| | - Kecheng Zhang
- Department of General SurgeryChinese PLA General Hospital China
| | - Jiyang Li
- Department of General SurgeryChinese PLA General Hospital China
| | - Naizhong Jin
- Department of General SurgeryChinese PLA General Hospital China
| | - Hongqi Xi
- Department of General SurgeryChinese PLA General Hospital China
| | - Bo Wei
- Department of General SurgeryChinese PLA General Hospital China
| | - Lin Chen
- Department of General SurgeryChinese PLA General Hospital China
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