Potential Applicability of Local Resection With Prophylactic Left Gastric Artery Basin Dissection for Early-Stage Gastric Cancer in the Upper Third of the Stomach.

IF 3.2 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Yoshimasa Akashi, Koichi Ogawa, Katsuji Hisakura, Tsuyoshi Enomoto, Yusuke Ohara, Yohei Owada, Shinji Hashimoto, Kazuhiro Takahashi, Osamu Shimomura, Manami Doi, Yoshihiro Miyazaki, Kinji Furuya, Shoko Moue, Tatsuya Oda
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引用次数: 0

Abstract

Purpose: Total or proximal gastrectomy of the upper-third early gastric cancer (u-EGC) often causes severe post-gastrectomy syndrome, suggesting that these procedures are extremely invasive for patients without pathologically positive lymph node (LN) metastasis. This study aimed to evaluate the clinical applicability of a stomach function-preserving surgery, local resection (LR), with prophylactic left gastric artery (LGA)-basin dissection (LGA-BD).

Materials and methods: The data of patients with u-EGC (pathologically diagnosed as T1) were retrospectively analyzed. Total gastrectomy was performed in 30 patients, proximal gastrectomy in 45, and subtotal gastrectomy in 6; the LN status was evaluated assuming that the patients had already underwent LR + LGA-BD. This procedure was considered feasible in patients without LN metastases or in patients with cancer in the LGA basin. The reproducibility of the results was also evaluated using an external validation dataset.

Results: Of the 82 eligible patients, 79 (96.3%) were cured after undergoing LR + LGA-BD, 74 (90.2%) were pathologically negative for LN metastases, and 5 (6.1%) had LN metastases, but these findings were only observed in the LGA basin. Similarly, of the 406 eligible tumors in the validation dataset, 396 (97.5%) were potentially curative. Tumors in the lesser curvature, post-endoscopic resection status, and small tumors (<20 mm) were considered to be stronger indicators of LR + LGA-BD as all subpopulation cases met our feasibility criteria.

Conclusions: More than 95% of the patients with u-EGC might be eligible for LR + LGA-BD. This function-preserving procedure may contribute to the development of u-EGC without pathological LN metastases, especially for tumors located at the lesser curvature.

Abstract Image

Abstract Image

Abstract Image

胃上1/3部位早期胃癌局部切除加预防性胃左动脉盆腔离断术的潜在适用性
目的:上三分之一早期胃癌(u-EGC)的全胃切除术或近端胃切除术通常会导致严重的胃切除术后综合征,这表明这些手术对于没有病理阳性淋巴结(LN)转移的患者来说具有极大的创伤性。本研究旨在评估保留胃功能的手术--局部切除术(LR)与预防性胃左动脉(LGA)-基底切除术(LGA-BD)的临床适用性:对u-EGC(病理诊断为T1)患者的数据进行回顾性分析。对30名患者进行了全胃切除术,45名患者进行了近端胃切除术,6名患者进行了次全胃切除术;假定患者已经接受了LR+LGA-BD手术,则对LN状态进行了评估。没有LN转移的患者或LGA盆地有癌症的患者都可以接受这种手术。此外,还使用外部验证数据集对结果的可重复性进行了评估:在82名符合条件的患者中,79人(96.3%)在接受LR+LGA-BD手术后治愈,74人(90.2%)LN转移病理阴性,5人(6.1%)有LN转移,但这些结果仅在LGA盆地观察到。同样,在验证数据集中的 406 个符合条件的肿瘤中,有 396 个(97.5%)有可能治愈。小弯肿瘤、内镜下切除术后状态和小肿瘤(结论:95%以上的泌尿系统肿瘤患者有治愈的可能:95%以上的u-EGC患者可能符合LR+LGA-BD的治疗条件。这种保留功能的手术可能有助于无病理LN转移的u-EGC的发展,尤其是位于小弯的肿瘤。
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来源期刊
Journal of Gastric Cancer
Journal of Gastric Cancer Biochemistry, Genetics and Molecular Biology-Cancer Research
CiteScore
4.30
自引率
12.00%
发文量
36
期刊介绍: The Journal of Gastric Cancer (J Gastric Cancer) is an international peer-reviewed journal. Each issue carries high quality clinical and translational researches on gastric neoplasms. Editorial Board of J Gastric Cancer publishes original articles on pathophysiology, molecular oncology, diagnosis, treatment, and prevention of gastric cancer as well as articles on dietary control and improving the quality of life for gastric cancer patients. J Gastric Cancer includes case reports, review articles, how I do it articles, editorials, and letters to the editor.
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