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Is it worthy of adding dissection of the superior mesenteric vein lymph node (14v) to standard D2 gastrectomy for distal gastric cancers with No. 6 lymph node metastasis?

  • J. Zhang
  • S. Zou
  • R. Luo
  • Z. Zhu
  • Z. Wang
  • H. XuEmail author
  • B. HuangEmail author
Research Article
  • 25 Downloads

Abstract

Purpose

Radical gastrectomy with D2 lymphadenectomy has been widely recognized as standard surgical procedure for advanced gastric cancer, while the role of No. 14v lymphadenectomy in distal gastric cancer remains controversial.

Methods

Clinicopathological data of 793 distal gastric cancer patients who underwent at least a radical D2 lymphadenectomy with No. 6 nodes metastasis were retrospectively reviewed.

Results

Fifty patients received No. 14v lymphadenectomy. Patients with No. 14v nodes metastasis (21/50, 42.0%) had poor prognosis. The No. 14v nodes metastasis was not an independent prognostic factor (P = 0.075). In distal gastric cancer patients with No. 6 nodes metastasis, No. 14v lymphadenectomy deteriorated overall survival, what’s more, No. 14v lymphadenectomy was an independent risk prognostic factor (hazard ratio: 1.404; 95% confidence interval 1.043–1.889; P = 0.025). There was no significant difference in overall or locoregional and other types of recurrence rate between the 14vD+ and the 14vD− groups. The proportion of complication rate was greater in 14vD+ group (P = 0.001).

Conclusion

Extended D2 gastrectomy including No. 14v lymphadenectomy seems to be associated with poor overall survival and increased complication rate of distal gastric cancer patients with No. 6 nodes metastasis.

Keywords

Gastric cancer No. 14v lymph node No. 6 metastasis Lymphadenectomy Prognosis 

Notes

Acknowledgments

First and foremost, I would like to show my deepest gratitude to my supervisors, Dr. Huimian Xu and Dr. Baojun Huang. I cannot finish my manuscript without their enlightening guidance and impressive patience. I won’t withhold my sincere appreciation to all the teachers and classmates in Department of Surgical Oncology of the First Affiliated Hospital of China Medical University, without their encouragement and support this manuscript cannot be completed. Besides, this work was supported by a grant from the National Natural Science Foundation of China (No. 81272716) and the Shenyang Municipal Science and Technology Plan Project (No. 17-231-1-49).

Funding

This work was supported by a grant from the National Natural Science Foundation of China (No. 81272716) and the Shenyang Municipal Science and Technology Plan Project (No. 17-231-1-49).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.CrossRefGoogle Scholar
  2. 2.
    Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–32.CrossRefGoogle Scholar
  3. 3.
    Goggins WB, Wong GK. Poor survival for US Pacific Islander cancer patients: evidence from the surveillance, epidemiology, and end results database: 1991 to 2004. J Clin Oncol. 2007;25:5738–41.CrossRefGoogle Scholar
  4. 4.
    Papenfuss WA, Kukar M, Oxenberg J, et al. Morbidity and mortality associated with gastrectomy for gastric cancer. Ann Surg Oncol. 2014;21:3008–14.CrossRefGoogle Scholar
  5. 5.
    Ahn JR, Jung M, Kim C, et al. Prognosis of pN3 stage gastric cancer. Cancer Res Treat. 2009;41:73–9.CrossRefGoogle Scholar
  6. 6.
    Xu DZ, Geng QR, Long ZJ, et al. Positive lymph node ratio is an independent prognostic factor in gastric cancer after D2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol. 2009;16:319–26.CrossRefGoogle Scholar
  7. 7.
    Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007;245:543–52.CrossRefGoogle Scholar
  8. 8.
    Adachi Y, Shiraishi N, Suematsu T, et al. Most important lymph node information in gastric cancer: multivariate prognostic study. Ann Surg Oncol. 2000;7:503–7.CrossRefGoogle Scholar
  9. 9.
    Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.CrossRefGoogle Scholar
  10. 10.
    Waddell T, Verheij M, Allum W, et al. Gastric cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Eur J Surg Oncol. 2014;40:584–91.CrossRefGoogle Scholar
  11. 11.
    Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer. 2011;14:97–100.CrossRefGoogle Scholar
  12. 12.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2014;2014(20):1–19.Google Scholar
  13. 13.
    Degiuli M, Sasako M, Ponti A. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. Br J Surg. 2014;101:23–31.CrossRefGoogle Scholar
  14. 14.
    Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.CrossRefGoogle Scholar
  15. 15.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma-2 nd English Edition. Gastric Cancer. 1998;1:10–24.CrossRefGoogle Scholar
  16. 16.
    Association Japanese Gastric Cancer. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.CrossRefGoogle Scholar
  17. 17.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.CrossRefGoogle Scholar
  18. 18.
    An JY, Pak KH, Inaba K, et al. Relevance of lymph node metastasis along the superior mesenteric vein in gastric cancer. Br J Surg. 2011;98:667–72.CrossRefGoogle Scholar
  19. 19.
    Masuda TA, Sakaguchi Y, Toh Y, et al. Clinical characteristics of gastric cancer with metastasis to the lymph node along the superior mesenteric vein (14v). Dig Surg. 2008;25:351–8.CrossRefGoogle Scholar
  20. 20.
    Eom BW, Joo J, Kim YW, et al. Improved survival after adding dissection of the superior mesenteric vein lymph node (14v) to standard D2 gastrectomy for advanced distal gastric cancer. Surgery. 2014;155:408–16.CrossRefGoogle Scholar
  21. 21.
    Liang Y, Wu L, Wang X, Ding X, et al. Positive impact of adding No. 14v lymph node to D2 dissection on survival for distal gastric cancer patients after surgery with curative intent. Chin J Cancer Res. 2015;27:580–7.Google Scholar
  22. 22.
    Zeng H, Zheng R, Guo Y, et al. Cancer survival in China, 2003–2005: a population-based study. Int J Cancer. 2015;136:1921–30.CrossRefGoogle Scholar
  23. 23.
    D’Angelica M, Gonen M, Brennan MF, et al. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg. 2004;240:808–16.CrossRefGoogle Scholar
  24. 24.
    Eom BW, Yoon H, Ryu KW, et al. Predictors of timing and patterns of recurrence after curative resection for gastric cancer. Dig Surg. 2010;27:481–6.CrossRefGoogle Scholar
  25. 25.
    Tokunaga M, Ohyama S, Hiki N, et al. Therapeutic value of lymph node dissection in advanced gastric cancer with macroscopic duodenum invasion: is the posterior pancreatic head lymph node dissection beneficial? Ann Surg Oncol. 2009;16:1241–6.CrossRefGoogle Scholar
  26. 26.
    Sasako M, McCulloch P, Kinoshita T, et al. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995;82:346–51.CrossRefGoogle Scholar
  27. 27.
    Blouhos K, Boulas KA, Tsalis K, et al. Right-sided bursectomy as an access plane for aesthetic resection of the posterior leaf of the lesser sac from the head of the pancreas en block with the No. 6 and 14v lymph nodes in advanced lower third gastric cancer. Surgery. 2015;158:1742.CrossRefGoogle Scholar
  28. 28.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Department of Surgical OncologyFirst Affiliated Hospital of China Medical UniversityShenyangPeople’s Republic of China

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