Can laparoscopic spleen-preserving splenic hilar lymph node dissection replace prophylactic splenectomy for proximal advanced gastric cancers that invade the greater curvature?

Kinoshita, Takahiro; Sato, Reo; Akimoto, Eigo; Yoshida, Misao; Harada, Junichiro; Nishiguchi, Yukiko

doi:10.1016/j.ejso.2020.11.133

Cited by 7 publications

(11 citation statements)

References 18 publications

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“…Since Hyung et al first reported on LSPSHL in 2008, a growing body of research has confirmed the safety and feasibility of LSPSHL, with significant advantages in preserving visceral function and promoting rapid recovery . Kinoshita et al compared the efficacy of LSPSHL with splenectomy for patients with APGC through propensity score matching and found that the 5-year OS and 5-year relapse-free survival in the LSPSHL group were better than in the splenectomy group. In the JCOG0110 study, all patients in the experimental group underwent splenectomy to thoroughly clear the SHLNs, which led to a higher postoperative complication rate than the control group (30.3% vs 16.1%; P < .001) .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion

Lin,

Xu,

Zheng

et al. 2024

JAMA Surg

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ImportanceSplenic hilar lymphadenectomy has been recommended for locally advanced proximal gastric cancer (APGC) involving the greater curvature. However, it is unclear whether laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) is associated with a long-term survival benefit for APGC without greater curvature invasion.ObjectiveTo present the 5-year follow-up data from a randomized clinical trial that compared laparoscopic total gastrectomy (D2 group) with D2 plus LSPSHL (D2 + No. 10 group) among patients with resectable APGC.Design, Setting, and ParticipantsThis is a post hoc secondary analysis of a randomized clinical trial that enrolled 536 patients with potentially resectable APGC (cT2-4a, N0 or N+, and M0) without greater curvature invasion from January 5, 2015, to October 10, 2018. All patients were tracked for at least 5 years. The final follow-up was on October 30, 2023.InterventionsPatients were randomly assigned in a 1:1 ratio to the D2 + No. 10 or D2 groups.Main Outcomes and MeasuresThe 5-year disease-free survival (DFS) and overall survival (OS) rates were measured. Recurrence patterns and causes of death were compared.ResultsA total of 526 patients (392 men [74.5%]; mean [SD] age, 60.6 [9.6] years) were included in the modified intent-to-treat analysis, with 263 patients in each group. The 5-year DFS rate was 63.9% (95% CI, 58.1%-69.7%) for the D2 + No. 10 group and 55.1% (95% CI, 49.1%-61.1%) for the D2 group (log-rank P = .04). A statistically significant difference was observed in the 5-year OS between the D2 + No. 10 group and the D2 group (66.2% [95% CI, 60.4%-71.9%] vs 57.4% [95% CI, 51.4%-63.4%]; log-rank P = .03). The No. 10 lymph node exhibited a therapeutic value index (TVI) of 6.5, surpassing that of Nos. 8a (TVI, 3.0), 11 (TVI, 5.8), and 12a (TVI, 0.8). A total of 86 patients in the D2 + No. 10 group (cumulative incidence, 32.7%) and 111 patients in the D2 group (cumulative incidence, 42.2%) experienced recurrence (hazard ratio, 0.72; 95% CI, 0.54-0.95; P = .02). The multivariable competing risk regression model demonstrated that D2 + No. 10 remained an independent protective factor for a lower 5-year cumulative recurrence rate after surgery (hazard ratio, 0.75; 95% CI, 0.56-1.00; P = .05). There was a significant difference in the 5-year cumulative recurrence rate at the No. 10 lymph node area between the 2 groups (D2 + No. 10 group vs D2 group: 0% vs 2.3% [n = 6]; P = .01).ConclusionsThis post hoc secondary analysis of a randomized clinical trial found that laparoscopic total gastrectomy with LSPSHL can improve the prognosis and reduce recurrence for APGC without greater curvature invasion. Future multicenter studies are warranted to validate these findings.Trial RegistrationClinicalTrials.gov Identifier: NCT02333721

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion

Lin,

Xu,

Zheng

et al. 2024

JAMA Surg

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“…Actually, randomized trial comparing laparoscopic and open spleen-preserving splenic hilar lymphadenectomy is conducted [37]. However, laparoscopic spleen-preserving splenic hilar lymph node dissection was introduced since 2012 at some advanced facilities in Japan [38] and our cohort include only few patients with laparoscopic gastrectomy. So, we consider that splenic hilar lymph node dissection without splenectomy were rarely performed in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Splenectomy for Proximal Gastric Cancer with Greater Curvature Invasion or Type 4 Tumor: a Propensity Score Analysis of a Multi‐Institutional Dataset

et al. 2021

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Background Splenectomy for proximal gastric cancer was found to have no survival benefit in a randomized trial clarifying the role of splenectomy (JCOG0110 study). However, since tumor with invasion to the greater curvature and Type 4 tumor were excluded in JCOG0110, the benefit of splenectomy for these tumors is not known. Methods A multicenter dataset of patients with gastric cancer who underwent gastrectomy between 2010 and 2014 was created. From the dataset, 114 eligible patients with proximal advanced gastric cancer with invasion to the greater curvature or Type 4 tumor were enrolled. There were 60 patients in the gastrectomy with splenectomy (Spx) group and 54 patients in the spleen‐preserving (Prs) group. To balance the essential variables, propensity score analysis was performed, estimating the propensity score with a logistic regression model. Adjusted overall survival (OS) and adjusted disease‐free survival (DFS) were estimated using the inverse probability of treatment weighting (IPTW) method. Results There were significant differences in age, performance status, comorbidity, macroscopic type, and clinical T stage between the Spx and Prs groups. The model for estimating the propensity score was well adapted (c‐statistic: 0.830, 95%CI: 0.754–0.906). Adjusted OS was identical between the two groups (HR = 1.089, 95%CI: 0.759–1.563; p = 0.644). The DFS curve of Prs group was consistently tended to be lower than Spx, but the difference was not significant (HR = 0.813, 95%CI: 0.572–1.156; p = 0.249). Conclusions The efficacy of splenectomy was minimal for proximal advanced gastric cancer even with invasion to the greater curvature or Type 4 tumor.

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“…However, since 2016, when the results of JCOG0110 first became available, we have only performed splenic hilar dissection with splenectomy for tumors that have invaded the greater curvature. 14 Either splenectomy 15 or a spleen‐preserving procedure 16 was chosen for dissection of the splenic hilar nodes. However, splenectomy was chosen if the tumor directly infiltrated neighboring organs, such as the pancreas or spleen, or the splenogastric ligament.…”

Section: Methodsmentioning

confidence: 99%

Survival outcomes of laparoscopic versus open total gastrectomy with nodal dissection for gastric cancer in a high‐volume Japanese center: A propensity score‐matched analysis

Kinoshita

Akimoto

Yura

et al. 2022

Annals of Gastroent Surgery

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Aim To compare the survival outcomes of laparoscopic total gastrectomy (LTG) with those of open total gastrectomy (OTG) in gastric cancer. Methods Using an in‐house database, this single‐center study reviewed clinical data for patients who underwent surgery for gastric adenocarcinoma in 2008–2018. The patients were divided into an LTG group and an OTG group. Results Data for 638 patients were screened. After exclusions, 580 patients (LTG, n = 212; OTG, n = 368) were enrolled. Noting that the OTG group included more advanced tumors, 1:1 propensity score matching was implemented to reduce any selection bias, leaving 326 patients (LTG, n = 163; OTG, n = 163; pStage I/II/III = 147/87/92) for further analysis. The operation time was longer and blood loss was less in the LTG group. The postoperative hospital stay was shorter in the LTG group than in the OTG group (9 d vs 10 d；P = .040). There was no significant difference in the incidence of grade III or worse postoperative complications (8.9% vs 11.0%). Five‐year overall survival was better in the LTG group (84.9% vs 73.5%; P = .0010, log‐rank test), but there was no significant difference in overall survival according to pStage (I, 93.0% vs 89.0%; II, 85.8% vs 77.5%; III, 64.1% vs 52.5%). There was a similar trend in relapse‐free survival. Distribution of recurrence sites was comparable. Conclusion LTG may provide survival outcomes similar to those of OTG when performed by an experienced surgical team. Further evidence is required for final conclusions, especially regarding its efficacy for stage II/III.

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Can laparoscopic spleen-preserving splenic hilar lymph node dissection replace prophylactic splenectomy for proximal advanced gastric cancers that invade the greater curvature?

Cited by 7 publications

References 18 publications

Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion

Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion

Efficacy of Splenectomy for Proximal Gastric Cancer with Greater Curvature Invasion or Type 4 Tumor: a Propensity Score Analysis of a Multi‐Institutional Dataset

Survival outcomes of laparoscopic versus open total gastrectomy with nodal dissection for gastric cancer in a high‐volume Japanese center: A propensity score‐matched analysis

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