Reappraise role of No. 10 lymphadenectomy for proximal gastric cancer in the era of minimal invasive surgery during total gastrectomy: a pooled analysis of 4 prospective trial.

Abstract

BACKGROUND:

For patients with locally advanced proximal gastric cancer (LAPGC), the individualized selection of patients with highly suspected splenic hilar (No. 10) lymph node (LN) metastasis to undergo splenic hilar lymphadenectomy, is a clinical dilemma. This study aimed to re-evaluate the feasibility and safety of laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) and to identify the population who would benefit from it.

METHODS:

A total of 1068 patients (D2 group = 409; D2 + No. 10 group = 659) who underwent laparoscopic total gastrectomy from four prospective trials between January 2015 and July 2019 were analyzed.

RESULTS:

No significant difference in the incidence (16.9% vs. 16.4%; P = 0.837) of postoperative complications were found between the two groups. The metastasis rate of No. 10 LN among patients in the D2 + No. 10 group was 10.3% (68/659). Based on the decision tree, patients with LAPGC with tumor invading the greater curvature (Gre), patients with non-Gre-invading LAPGC with a tumor size > 5 cm and clinical positive locoregional LNs were defined as the high-priority No. 10 dissection group. The metastasis rate of No. 10 LNs in the high-priority group was 19.4% (41/211). In high-priority group, the 3-year overall survival of the D2 + No. 10 group was better than that of the D2 group (74.4% vs. 42.1%; P = 0.005), and the therapeutic index of No. 10 was higher than the indices of most suprapancreatic stations.

CONCLUSIONS:

LSPSHL for LAPGC is safe and feasible when performed by experienced surgeons. LSPSHL could be recommended for the high-priority group patients even without invasion of the Gre.

• Authors: Qing Zhong, Qi-Yue Chen, Yan-Chang Xu, Gang Zhao, Li-Sheng Cai, Guo-Xin Li, Ze-Kuan Xu, Su Yan, Zu-Guang Wu, Fang-Qin Xue, Yi-Hong Sun, Dong-Po Xu, Wen-Bin Zhang, Jin Wan, Pei-Wu Yu, Jian-Kun Hu, Xiang-Qian Su, Jia-Fu Ji, Zi-Yu Li, Jun You, Yong Li, Lin Fan, Chao-Hui Zheng, Jian-Wei Xie, Ping Li, Chang-Ming Huang
• Journal: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association (Gastric Cancer) Vol. 24 Issue 1 Pg. 245-257 (Jan 2021) ISSN: 1436-3305 [Electronic] Japan
• PMID: 32712769 (Publication Type: Journal Article, Meta-Analysis)

Topics

• Clinical Trials as Topic
• Feasibility Studies
• Female
• Gastrectomy (adverse effects, methods)
• Humans
• Incidence
• Intention to Treat Analysis
• Laparoscopy (adverse effects, methods)
• Lymph Node Excision (adverse effects, methods)
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Invasiveness
• Organ Sparing Treatments (adverse effects, methods)
• Postoperative Complications (epidemiology, etiology)
• Propensity Score
• Prospective Studies
• Spleen (surgery)
• Stomach Neoplasms (pathology, surgery)