Bang Wool Eom1, Jungnam Joo2, Young-Woo Kim3, Daniel Reim1, Ji Yeon Park1, Hong Man Yoon1, Keun Won Ryu1, Jong Yeul Lee1, Myeong-Cherl Kook1. 1. Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea. 2. Biometric Research Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea. 3. Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea. Electronic address: gskim@ncc.re.kr.
Abstract
BACKGROUND: Extended lymph node dissection in gastric cancer (D3) was proven to have no survival benefit compared with a D2 dissection, but whether adding the superior mesenteric nodes (No. 14v) to the dissection provides survival benefit for gastric cancer patients remains controversial. METHODS: From April 2001 to June 2007, 1,661 patients underwent curative resection for middle or lower third gastric cancer. Patients were grouped according to No. 14v lymphadenectomy (14vD+/14vD-). Clinicopathologic characteristics and treatment-related factors were compared between the groups. Overall survival according to the clinical stage (Union for International Cancer Control tumor-node-metastasis staging 6th edition) was analyzed using the Cox proportional hazard model. RESULTS: The incidence of No. 14v lymph node metastasis was 5.0%. There was no difference in morbidity or mortality between the 14vD+ and the 14vD- groups. The proportion of locoregional recurrence was greater in 14vD- group (P = .018). In clinical stages I and II, 14v lymph node dissection did not affect overall survival; in contrast, 14v lymph node dissection was an independent prognostic factor in patients with clinical stage III/IV gastric cancer (hazard ratio, 0.58; 95% confidence interval, 0.38-0.88; P = .01). CONCLUSION: Extended D2 gastrectomy including No. 14v lymph node dissection seems to be associated with improved overall survival of patients with clinical stage III/IV gastric cancer in the middle or lower third of the stomach.
BACKGROUND: Extended lymph node dissection in gastric cancer (D3) was proven to have no survival benefit compared with a D2 dissection, but whether adding the superior mesenteric nodes (No. 14v) to the dissection provides survival benefit for gastric cancerpatients remains controversial. METHODS: From April 2001 to June 2007, 1,661 patients underwent curative resection for middle or lower third gastric cancer. Patients were grouped according to No. 14v lymphadenectomy (14vD+/14vD-). Clinicopathologic characteristics and treatment-related factors were compared between the groups. Overall survival according to the clinical stage (Union for International Cancer Control tumor-node-metastasis staging 6th edition) was analyzed using the Cox proportional hazard model. RESULTS: The incidence of No. 14v lymph node metastasis was 5.0%. There was no difference in morbidity or mortality between the 14vD+ and the 14vD- groups. The proportion of locoregional recurrence was greater in 14vD- group (P = .018). In clinical stages I and II, 14v lymph node dissection did not affect overall survival; in contrast, 14v lymph node dissection was an independent prognostic factor in patients with clinical stage III/IV gastric cancer (hazard ratio, 0.58; 95% confidence interval, 0.38-0.88; P = .01). CONCLUSION: Extended D2 gastrectomy including No. 14v lymph node dissection seems to be associated with improved overall survival of patients with clinical stage III/IV gastric cancer in the middle or lower third of the stomach.
Authors: Maurizio Degiuli; Giovanni De Manzoni; Alberto Di Leo; Domenico D'Ugo; Erica Galasso; Daniele Marrelli; Roberto Petrioli; Karol Polom; Franco Roviello; Francesco Santullo; Mario Morino Journal: World J Gastroenterol Date: 2016-03-14 Impact factor: 5.742