Gan to kagaku ryoho. Cancer & chemotherapy · 2015
[Therapeutic Value of Lymphadenectomy and Prediction of Station No. 1 Lymph Node Metastasis in Lower-Third Gastric Cancers].
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Hamada Junichi, Komatsu Shuhei, Kosuga Toshiyuki, Ichikawa Daisuke, Okamoto Kazuma, Konishi Hirotaka, Shiozaki Atsushi, Fujiwara Hitoshi, Arita Tomohiro, Morimura Ryo, Murayama Yasutoshi, Ikoma Hisashi, Kuriu Yoshiaki, Nakanishi Masayoshi, Otsuji Eigo
Аннотация
BACKGROUND: According to the 14th Japanese Classification of Gastric Carcinoma(JCGC), station No. 1 lymphadenectomy for distal gastrectomy was included in the D1 level, though the 13th JCGC classified station No. 1 lymphadenectomy to the D2 level in patients with primary lower-third gastric cancer (LGC). This study was designed to re-evaluate the therapeutic value of lymphadenectomy, and to clarify the possible risk factors for station No. 1 lymph node metastasis (LNM) in LGC.
METHODS: Between 1997 and 2014, 1,875 consecutive patients with gastric cancer underwent curative gastrectomy with radical lymphadenectomy. Of these, 344 patients who had a tumor located in the lower (L) or lower-duodenum (LD) area were analyzed retrospectively.
RESULTS: 1) The therapeutic value of lymphadenectomy of stations No. 6, No. 3, No. 8a, No. 5, No. 4d, and No. 1 lymph nodes was proved to be higher than that of lymphadenectomy of other station lymph nodes. Patients with station No. 1 LNM had a significantly higher incidence of undifferentiated type, lymphatic invasion, venous invasion, and pT2-4 tumor. 2) Regarding factors to predict station No. 1 LNM in LGC, there was no station No. 1 LNM in patients with both early and differentiated type LGC. Distance from the pylorus to the tumor center (DPT) significantly correlated with station No. 1 LNM. Particularly, there was no station No. 1 LNM in patients with early LGC and DPT<50 mm.
CONCLUSIONS: In patients with early and differentiated type LGC and DPT<50 mm, limited surgery to omit station No. 1 lymphadenectomy might be possible.
METHODS: Between 1997 and 2014, 1,875 consecutive patients with gastric cancer underwent curative gastrectomy with radical lymphadenectomy. Of these, 344 patients who had a tumor located in the lower (L) or lower-duodenum (LD) area were analyzed retrospectively.
RESULTS: 1) The therapeutic value of lymphadenectomy of stations No. 6, No. 3, No. 8a, No. 5, No. 4d, and No. 1 lymph nodes was proved to be higher than that of lymphadenectomy of other station lymph nodes. Patients with station No. 1 LNM had a significantly higher incidence of undifferentiated type, lymphatic invasion, venous invasion, and pT2-4 tumor. 2) Regarding factors to predict station No. 1 LNM in LGC, there was no station No. 1 LNM in patients with both early and differentiated type LGC. Distance from the pylorus to the tumor center (DPT) significantly correlated with station No. 1 LNM. Particularly, there was no station No. 1 LNM in patients with early LGC and DPT<50 mm.
CONCLUSIONS: In patients with early and differentiated type LGC and DPT<50 mm, limited surgery to omit station No. 1 lymphadenectomy might be possible.