Key nodal stations for predicting splenic hilar nodal metastasis in upper advanced gastric cancer without invasion of the greater curvature

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Masashi Nishino, Takaki Yoshikawa, Masahiro Yura, Rei Ogawa, Ryota Sakon, Kenichi Ishizu, Takeyuki Wada, Tsutomu Hayashi, Yukinori Yamagata
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Abstract

Background

Standard surgery for upper advanced gastric cancer without invasion of the greater curvature (UGC-GC) is spleen-preserving D2 total gastrectomy without dissection of the splenic-hilar nodes (#10). However, some patients with nodal metastasis to #10 survive more than 5 years due to nodal dissection of #10. If nodal metastasis to #10 is predictable based on the positivity of other nodes dissected by the current standard surgery without #10 nodal dissection, physicians may be able to consider #10 dissection.

Methods

This study retrospectively reviewed data from the National Cancer Center Hospital in Japan between 2000 and 2012. We selected cases that met the following criteria: (1) D2 or more total gastrectomy with splenectomy, (2) UGC-GC, and (3) histological type is gastric adenocarcinoma. We performed univariate and multivariate analyses concerning lymph node stations associated with #10 metastasis.

Results

A total of 366 patients were examined. A multivariate analysis revealed that #10 metastasis was associated with positivity of the nodes along the short gastric arteries (#4sa) and distal nodes along the splenic artery (#11d) (#4sa: p = 0.003, #11d: p = 0.016). When either key node was positive, the metastatic rate of #10 was 24.4%, and the therapeutic value index was 13.3.

Conclusions

#4sa and #11d were key lymph nodes predicting #10 nodal metastasis in UGC-GC. When these key nodes are positive on computed tomography before surgery or according to a rapid pathological examination during surgery, dissection of #10 should be considered even if upper advanced tumors are not invading the greater curvature.

Abstract Image

预测未侵犯大弯的上部晚期胃癌脾门结节转移的关键结节站
无大弯侵犯的上部晚期胃癌(UGC-GC)的标准手术是保脾 D2 全胃切除术,不切除脾-肝结节(#10)。但是,一些 10 号结节转移的患者会因为 10 号结节切除而存活 5 年以上。本研究回顾性审查了日本国立癌症中心医院在 2000 年至 2012 年期间的数据。我们选择了符合以下标准的病例:(1)D2或以上全胃切除术加脾切除;(2)UGC-GC;(3)组织学类型为胃腺癌。我们对与 10 号转移相关的淋巴结站进行了单变量和多变量分析。多变量分析显示,10号转移与沿胃短动脉的淋巴结(4号sa)和沿脾动脉的远端淋巴结(11号d)阳性有关(4号sa:p = 0.003,11号d:p = 0.016)。4sa和11d是预测UGC-GC中10号结节转移的关键淋巴结。当术前计算机断层扫描或术中快速病理检查显示这些关键结节阳性时,即使上部晚期肿瘤未侵犯大弯,也应考虑切除10号结节。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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