Abstract
ObjectiveThe current surgical treatment guidelines for early proximal gastric cancer (PGC) still lack agreement. Lymphadenectomy of lymph nodes No. 5 and No. 6 is the major difference between total and proximal gastrectomy. We elucidated the appropriate surgical procedure for PGC by investigating the pathological characteristics and prognostic significance of lymph nodes No. 5 and No. 6.MethodsIn total, 333 PGC patients who underwent total gastrectomy were enrolled in this study. We investigated their clinicopathological characteristics and the metastatic patterns of the lymph nodes. Patients with metastasis in lymph nodes No. 5 and No. 6 were combined into one group and we compared the difference in survival between those with and without metastasis in lymph nodes No. 5, 6 (lymph nodes No. 5 and No. 6 in any group of metastasis) for different subgroups.ResultsThe metastatic rates for lymph nodes No. 5 and No. 6 in PGC were 9.91% and 16.11%, respectively. The metastatic rate for both lymph nodes No. 5, 6 was 20.42%. Multivariate analysis showed that positive metastasis in lymph node No. 4, depth of invasion, and tumor size were independently correlated with the presence of metastasis in lymph nodes No. 5, 6.ConclusionsWhen lymph node No. 4 is positive (intraoperative pathology) or tumor size ≥5 cm or T4 stage, lymphadenectomy should be performed for lymph nodes No. 5 and No. 6, and total gastrectomy is recommended.
Highlights
Gastric cancer is a common digestive system malignant tumor throughout the world, and it had the fifth highest incidence and the third mortality rate after lung cancer [1,2]
Chinese Journal of Cancer Research, Vol 31, No 1 February 2019 in No 5 lymph nodes, 51 (16.11%) patients were positive in No 6 lymph nodes, with an overlap for 16 patients who had metastasis in both lymph nodes No 5 and No 6, and 68 (20.42%) patients were positive in lymph nodes No 5, 6
Our data showed that the clinicopathological factors comprising tumor size and depth of invasion were risk factors for metastasis in lymph nodes No 5 and No 6 according to univariate analysis (Table 1)
Summary
Gastric cancer is a common digestive system malignant tumor throughout the world, and it had the fifth highest incidence and the third mortality rate after lung cancer [1,2]. Lymph nodes No 5 and No 6 are defined as the third metastatic region, which indicates a low overall survival (OS) rate and poor prognosis [6]. Total gastrectomy with D2 lymphadenectomy is indicated in patients with advanced PGC as the standard treatment in the JGCA guidelines (14th edition). Lymphadenectomy of lymph nodes No 5 and No 6 plays a key role in the decision regarding surgical treatment. According to these considerations, we analyzed the pathological characteristics and prognostic significance of metastasis in lymph nodes No 5 and No 6 for PGC patients
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