Cas de Jongh1,2, Lianne Triemstra3, Arjen van der Veen3, Lodewijk A A Brosens3,4, Misha D P Luyer5, Jan H M B Stoot6, Jelle P Ruurda3, Richard van Hillegersberg3. 1. Department of Surgery, University Medical Center (UMC) Utrecht, G04.228. 3508 GA, Utrecht, The Netherlands. C.deJongh@umcutrecht.nl. 2. Department of Pathology, UMC Utrecht, Utrecht, The Netherlands. C.deJongh@umcutrecht.nl. 3. Department of Surgery, University Medical Center (UMC) Utrecht, G04.228. 3508 GA, Utrecht, The Netherlands. 4. Department of Pathology, UMC Utrecht, Utrecht, The Netherlands. 5. Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. 6. Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands.
Abstract
BACKGROUND: The relation between gastric cancer characteristics and lymph node (LN) metastatic patterns is not fully clear, especially following neoadjuvant chemotherapy (NAC). This study analyzed nodal metastatic patterns. METHODS: Individual LN stations were analyzed for all patients from the LOGICA-trial, a Dutch multicenter randomized trial comparing laparoscopic versus open D2-gastrectomy for gastric cancer. The pattern of metastases per LN station was related to tumor location, cT-stage, Lauren classification and NAC. RESULTS: Between 2015-2018, 212 patients underwent D2-gastrectomy, of whom 158 (75%) received NAC. LN metastases were present in 120 patients (57%). Proximal tumors metastasized predominantly to proximal LN stations (no. 1, 2, 7 and 9; p < 0.05), and distal tumors to distal LN stations (no. 5, 6 and 8; OR > 1, p > 0.05). However, distal tumors also metastasized to proximal LN stations, and vice versa. Despite NAC, each LN station (no. 1-9, 11 and 12a) showed metastases, regardless of tumor location, cT-stage, histological subtype and NAC treatment, including station 12a for cT1N0-tumors. LN metastases were present more frequently in diffuse versus intestinal tumors (66% versus 52%; p = 0,048), but not for cT3-4- versus cT1-2-stage (59% versus 51%; p = 0.259). However, the pattern of LN metastases was similar for these subgroups. CONCLUSIONS: The extent of lymphadenectomy cannot be reduced after NAC for gastric cancer. Although the pattern of LN metastases is related to tumor location, all LN stations contained metastases regardless of tumor location, cT-stage (including cT1N0-tumors), histological subtype, or NAC treatment. Therefore, D2-lymphadenectomy should be routinely performed during gastrectomy in Western patients.
BACKGROUND: The relation between gastric cancer characteristics and lymph node (LN) metastatic patterns is not fully clear, especially following neoadjuvant chemotherapy (NAC). This study analyzed nodal metastatic patterns. METHODS: Individual LN stations were analyzed for all patients from the LOGICA-trial, a Dutch multicenter randomized trial comparing laparoscopic versus open D2-gastrectomy for gastric cancer. The pattern of metastases per LN station was related to tumor location, cT-stage, Lauren classification and NAC. RESULTS: Between 2015-2018, 212 patients underwent D2-gastrectomy, of whom 158 (75%) received NAC. LN metastases were present in 120 patients (57%). Proximal tumors metastasized predominantly to proximal LN stations (no. 1, 2, 7 and 9; p < 0.05), and distal tumors to distal LN stations (no. 5, 6 and 8; OR > 1, p > 0.05). However, distal tumors also metastasized to proximal LN stations, and vice versa. Despite NAC, each LN station (no. 1-9, 11 and 12a) showed metastases, regardless of tumor location, cT-stage, histological subtype and NAC treatment, including station 12a for cT1N0-tumors. LN metastases were present more frequently in diffuse versus intestinal tumors (66% versus 52%; p = 0,048), but not for cT3-4- versus cT1-2-stage (59% versus 51%; p = 0.259). However, the pattern of LN metastases was similar for these subgroups. CONCLUSIONS: The extent of lymphadenectomy cannot be reduced after NAC for gastric cancer. Although the pattern of LN metastases is related to tumor location, all LN stations contained metastases regardless of tumor location, cT-stage (including cT1N0-tumors), histological subtype, or NAC treatment. Therefore, D2-lymphadenectomy should be routinely performed during gastrectomy in Western patients.
Authors: M Ri; S Nunobe; M Honda; E Akimoto; T Kinoshita; S Hori; M Aizawa; H Yabusaki; Y Isobe; H Kawakubo; T Abe Journal: Br J Surg Date: 2020-05-20 Impact factor: 6.939
Authors: E J Jongerius; D Boerma; K A Seldenrijk; S L Meijer; J J G Scheepers; F Smedts; S M Lagarde; O Balague Ponz; M I van Berge Henegouwen; J W van Sandick; S S Gisbertz Journal: Br J Surg Date: 2016-08-23 Impact factor: 6.939
Authors: Soo Young Kim; Yoon Young Choi; Ji Yeong An; Hyun Beak Shin; Ara Jo; Hyeji Choi; Sang Hyuk Seo; Hui-Jae Bang; Jae-Ho Cheong; Woo Jin Hyung; Sung Hoon Noh Journal: Int J Cancer Date: 2015-02-26 Impact factor: 7.396