Clinical Characteristics of Gastric Cancer with Metastasis to the Lymph Node along the Superior Mesenteric Vein (14v)

Abstract

Aim: We investigated the clinical significance of metastasis to the lymph node (LN) along the superior mesenteric vein (14v) in gastric cancer. Methods: A retrospective study of 2,513 gastrectomy patients with a 14v dissection was done using the Ganken Igan Database. Results: The incidence of 14v metastasis correlated with tumor location, depth of tumor invasion, regional LN metastases, peritoneal metastasis, peritoneal cytology-positive, hepatic metastasis and postoperative recurrence (p < 0.01). Metastases to the infrapyloric LN (6), suprapyloric LN (5) and left paracardial LN (2) were independent variables affecting 14v metastasis (p < 0.05), and the 6 status was a useful predictive factor for a 14v-negative status with a low false-negative rate (1.9%). The patients with 14v metastasis after curative surgery demonstrated a significantly lower survival rate than those without (5-year overall survival rate; 11.3 vs. 60.2%, p < 0.0001). In them, LN around the abdominal aorta (16)-positive group showed a significantly lower survival rate than the negative group (p < 0.05). Conclusions: Advanced gastric cancer with invasion to the lower stomach often metastasizes to 14v, and the 6 status can predict 14v negative. Most patients with 14v metastasis have a poor prognosis, similar to those with systemic metastasis, although some such patients may benefit from a curative dissection.

Relevance of lymph node metastasis along the superior mesenteric vein in gastric cancer

“…The frequency of 14v metastasis has been reported to be between 10 and 20 per cent in advanced-stage distal gastric cancer 6,15 . It has been suggested that some patients with 14v metastasis may derive benefit from 14v dissection, and it is important to identify such patients accurately.…”

“…The need for 14v dissection is based on the anatomical location in the lymphatic drainage pathway and on the frequency of 14v metastasis reported in several Japanese studies 4,5 . Although the incidence of 14v metastasis is very low in early-stage gastric cancer at 1·3 per cent, it rises to 19·7 per cent in advanced gastric cancer 6 . The clinical significance and prognostic value of 14v metastasis has been investigated in Japanese studies, but has not been analysed worldwide.…”

Recent Evolution of Surgical Treatment for Gastric Cancer in Korea

“…(35) The clinical significance of lymph node no.14v metastasis was evaluated in a large-scaled Japanese study, and the prognostic impact of 14v lymph node metastasis seems to be strong. (36) The authors suggested that the prognosis of patients with 14v metastasis was similar to those with systemic metastasis and only some patients had a chance to be cured by 14v dissection. In a retrospective Korean study, authors suggested a subgroup of gastric cancer getting merits from 14v dissection.…”

Five-year Survival Associated with Stage I Gastric Cancer after Resection of Early Recurrence at Nodal Station No. 14v: a Case Report

“…6 metastasis is a pivotal risk factor for a No. 14v metastasis [9]. In addition to the presented case, previous studies demonstrate that there is a lymphatic pathway from the infra-pyloric area to around the mesenteric superior vein/artery.…”