A Reappraisal of Lymph Node Dissection for Gastric Adenocarcinoma during Upfront Gastrectomy-An Institutional Report.

IF 0.9 4区医学 Q3 SURGERY

Annali italiani di chirurgia Pub Date : 2025-01-01 DOI:10.62713/aic.3552

Chun-Hao Lee, Hui-Ting Lee, Shin-Ting Yeh, Chang-Youh Tsai, Heng-Hui Lien, Chen-Sung Lin

{"title":"A Reappraisal of Lymph Node Dissection for Gastric Adenocarcinoma during Upfront Gastrectomy-An Institutional Report.","authors":"Chun-Hao Lee, Hui-Ting Lee, Shin-Ting Yeh, Chang-Youh Tsai, Heng-Hui Lien, Chen-Sung Lin","doi":"10.62713/aic.3552","DOIUrl":null,"url":null,"abstract":"Aim: The role of lymph node dissection (LND) in gastric adenocarcinoma (GAC) remained some controversy. This study reappraised the clinical implications of LND for GAC in terms of the numbers of total lymph node (TLN), positive lymph node (PLN) and negative lymph node (NLN).Methods: A total of 106 GAC patients receiving an upfront gastrectomy (laparoscopic/laparotomy surgery, 19/87) with LND (D1/D1+/D2 dissection, 5/53/48) between Jan 2017 and Dec 2021 in Cathay General Hospital, Taipei were analyzed. The surgical-pathological T-/N-/M-status and cancer stage were determined according to the American Joint Committee on Cancer (AJCC) 8th edition. The numbers of TLN, PLN and NLN were recorded for analysis (TLN = PLN + NLN). The associations between prognosis and related variables, including pathological findings, the clinical implications of TLN/PLN/NLN and extent for LND, were all deeply studied.Results: Advanced T-status (p < 0.001), N-status (p = 0.025), M-status (p = 0.001) and cancer stage (p = 0.001) had a negative effect on survival. The severity of N-status was associated with the progression of T-status (p < 0.001), M-status (p = 0.015) and cancer stage (p < 0.001). For all 106 GAC patients (p = 0.002/0.017) and the 25 T1 GAC patients (p = 0.052/0.015), those undergoing TLN >17 (≥18) had a more PLN and a higher rate of N(+) than those ≤17. For 65 N(+) GAC patients, an extension of TLN to ≥23 allowed the detection of a median value for PLN of 7, the N3-status. NLN >9 (≥10) was related to a better prognosis (p = 0.066) and lower HR (p = 0.073) for N(+) GAC patients. TLN with threshold value ≥20 owned the best power to distinguish NLN >9 (≥10) from ≤9 among N(+) GAC patients (p < 0.001). A D2 dissection could achieve these thresholds, including TLN ≥18 (p = 0.001) for GAC patients, TLN ≥23 (p = 0.028) for N(+) GAC patients, and NLN ≥10 (p = 0.012) as well as TLN ≥20 (p = 0.011) for N(+) GAC patients, more effectively than a D1/D1+ dissection.Conclusions: A value of TLN ≥18 is necessary for de-novo GAC patients during gastrectomy to detect possible N(+) status, and ≥23 is recommended for N(+) GAC patients to identify the possible N3-status. A value of NLN ≥10 could reach a better survival for N(+) GAC patients and it requires a value of TLN ≥20 to achieve. A D2 dissection is recommended for GAC patients during gastrectomy. LND establishes adequate N-status staging and increases survival for GAC patients.","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"228-243"},"PeriodicalIF":0.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annali italiani di chirurgia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.62713/aic.3552","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Aim: The role of lymph node dissection (LND) in gastric adenocarcinoma (GAC) remained some controversy. This study reappraised the clinical implications of LND for GAC in terms of the numbers of total lymph node (TLN), positive lymph node (PLN) and negative lymph node (NLN).

Methods: A total of 106 GAC patients receiving an upfront gastrectomy (laparoscopic/laparotomy surgery, 19/87) with LND (D1/D1+/D2 dissection, 5/53/48) between Jan 2017 and Dec 2021 in Cathay General Hospital, Taipei were analyzed. The surgical-pathological T-/N-/M-status and cancer stage were determined according to the American Joint Committee on Cancer (AJCC) 8th edition. The numbers of TLN, PLN and NLN were recorded for analysis (TLN = PLN + NLN). The associations between prognosis and related variables, including pathological findings, the clinical implications of TLN/PLN/NLN and extent for LND, were all deeply studied.

Results: Advanced T-status (p < 0.001), N-status (p = 0.025), M-status (p = 0.001) and cancer stage (p = 0.001) had a negative effect on survival. The severity of N-status was associated with the progression of T-status (p < 0.001), M-status (p = 0.015) and cancer stage (p < 0.001). For all 106 GAC patients (p = 0.002/0.017) and the 25 T1 GAC patients (p = 0.052/0.015), those undergoing TLN >17 (≥18) had a more PLN and a higher rate of N(+) than those ≤17. For 65 N(+) GAC patients, an extension of TLN to ≥23 allowed the detection of a median value for PLN of 7, the N3-status. NLN >9 (≥10) was related to a better prognosis (p = 0.066) and lower HR (p = 0.073) for N(+) GAC patients. TLN with threshold value ≥20 owned the best power to distinguish NLN >9 (≥10) from ≤9 among N(+) GAC patients (p < 0.001). A D2 dissection could achieve these thresholds, including TLN ≥18 (p = 0.001) for GAC patients, TLN ≥23 (p = 0.028) for N(+) GAC patients, and NLN ≥10 (p = 0.012) as well as TLN ≥20 (p = 0.011) for N(+) GAC patients, more effectively than a D1/D1+ dissection.

Conclusions: A value of TLN ≥18 is necessary for de-novo GAC patients during gastrectomy to detect possible N(+) status, and ≥23 is recommended for N(+) GAC patients to identify the possible N3-status. A value of NLN ≥10 could reach a better survival for N(+) GAC patients and it requires a value of TLN ≥20 to achieve. A D2 dissection is recommended for GAC patients during gastrectomy. LND establishes adequate N-status staging and increases survival for GAC patients.

查看原文本刊更多论文

胃前部切除术中淋巴结清扫对胃腺癌的再评价——一份机构报告。

目的：淋巴结清扫（LND）在胃腺癌（GAC）中的作用仍有争议。本研究从总淋巴结（TLN）、阳性淋巴结（PLN）和阴性淋巴结（NLN）的数量方面重新评估了LND对GAC的临床意义。方法：分析2017年1月至2021年12月台北国泰总医院行术前胃切除术（腹腔镜/开腹手术，19/87）合并LND （D1/D1+/D2夹层，5/53/48）的106例GAC患者。根据美国癌症联合委员会（AJCC）第8版确定手术病理T-/N-/ m状态和癌症分期。记录TLN、PLN和NLN的数量进行分析（TLN = PLN + NLN）。我们深入研究了预后与相关变量的关系，包括病理表现、TLN/PLN/NLN的临床意义以及LND的程度。结果：晚期t状态（p < 0.001）、n状态（p = 0.025）、m状态（p = 0.001）和肿瘤分期（p = 0.001）对生存率有负影响。n状态的严重程度与t状态（p < 0.001）、m状态（p = 0.015）和肿瘤分期（p < 0.001）相关。106例GAC患者（p = 0.002/0.017）和25例T1期GAC患者（p = 0.052/0.015）中，TLN≥17（≥18）的患者PLN和N（+）率均高于≤17的患者。对于65例N(+) GAC患者，TLN延长至≥23可以检测到PLN的中位数为7，即n3状态。NLN bbb9（≥10）与N(+) GAC患者预后较好（p = 0.066）、HR较低（p = 0.073）相关。阈值≥20的TLN在N(+) GAC患者中区分NLN >9（≥10）和≤9的能力最强（p < 0.001）。D2夹层可以达到这些阈值，包括GAC患者TLN≥18 (p = 0.001)， N(+) GAC患者TLN≥23 (p = 0.028)， N(+) GAC患者NLN≥10 （p = 0.012）和TLN≥20 (p = 0.011)，比D1/D1+夹层更有效。结论：胃切除术中新生GAC患者需要TLN≥18来判断可能的N（+）状态，建议TLN≥23来判断N(+) GAC患者可能的n3状态。N(+) GAC患者NLN≥10可达到较好的生存期，TLN≥20才能达到。GAC患者在胃切除术时建议行D2夹层。LND建立了足够的n状态分期，提高了GAC患者的生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Annali italiani di chirurgia 医学-外科

CiteScore

0.90

自引率

12.50%

发文量

116

审稿时长

>12 weeks

期刊介绍： Annali Italiani di Chirurgia is a bimonthly journal and covers all aspects of surgery:elective, emergency and experimental surgery, as well as problems involving technology, teaching, organization and forensic medicine. The articles are published in Italian or English, though English is preferred because it facilitates the international diffusion of the journal (v.Guidelines for Authors and Norme per gli Autori). The articles published are divided into three main sections:editorials, original articles, and case reports and innovations.