Comparison of Surgical Results of D2 Versus D3 Gastrectomy (Para-Aortic Lymph Node Dissection) for Advanced Gastric Carcinoma: A Multi-Institutional Study

Kunisaki, Chikara; Akiyama, Hirotoshi; Nomura, Masato; Matsuda, Goro; Otsuka, Yuichi; Ono, Hideki; Nagahori, Yutaka; Hosoi, Hideo; Takahashi, Mutsuo; Kito, Fumihiko; Shimada, Hiroshi

doi:10.1245/aso.2006.07.015

Cited by 63 publications

(36 citation statements)

References 10 publications

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“…Finally, the tumor size was identified as a prognostic factor in the current study. Some previous investigators have also demonstrated a survival benefit of PALN dissection in patients with tumor diameters of 50 to 100 mm, while PALN dissection did not improve the prognosis of patients with a tumor diameter of >100 mm (23). This may be explained by the fact that a predominant recurrence pattern of a very large tumor with serosal exposure might be associated with peritoneal metastasis.…”

Section: Discussionmentioning

confidence: 93%

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Kaito

Kinoshita

Tokunaga

et al. 2017

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Abstract. Background: The role of para-aortic lymph node (PALN) dissection for far-advanced gastric cancer is controversial in patients with tumor diameter of ≥120 mm (HR=3.37;. Patients with none of these factors survived significantly longer than those with any of these factors respectively; p<0.001). Conclusion: Pathologically PALN-positive patients achieve long survival; however, the indications for PALN dissection should be carefully considered.Para-aortic lymph node (PALN) metastasis from gastric cancer is classified as distant metastasis in both the 7th classification of the International Union against Cancer (1) and the 3rd English edition of the Japanese Gastric Cancer Classification (2). Thus, systemic chemotherapy is recommended as first-choice treatment in the current guidelines (3). In patients with advanced gastric cancer, the reported incidence of pathological metastasis to the PALNs is 8.5-30.0% (4-8). In one study, micrometastasis was detected by immunohistochemical staining in 64% of patients who underwent prophylactic PALN dissection (9). In several Japanese specialized centers, including ours, prophylactic PALN dissection was aggressively performed for advanced gastric cancer from the 1980s to the early 1990s. In 1995, a multi-institutional prospective randomized controlled trial comparing standard D2 dissection versus D2 plus PALN dissection for serosa-positive advanced gastric cancer without gross metastasis to the PALNs was conducted in Japan (JCOG9501) (10). This trial proved that the 5-year overall survival (OS) rates did not differ between the two groups (69.2% vs. 70.3%, respectively) and concluded that prophylactic PALN dissection is not effective (6). However, the incidence of pathologically positive PALNs in this trial was only 8.5%; thus, the benefit of PALN dissection for those patients could not be fully investigated.In general, the prognosis of patients with pathologicallypositive PALNs is thought to be unfavorable, even after systematic PALN dissection. However, it is known that a certain subpopulation of these patients can achieve long survival. The reported postoperative 5-year survival rate of patients with pathologically-positive PALNs is 16-25% (4, 6, 8, 11, 12). Due to progress in modern powerful perioperative chemotherapy regimens, it was recently suggested that the prognosis of these patients can be improved. A recent phase II trial (JCOG 0405) investigated the feasibility of neoadjuvant chemotherapy (2-3 cycles of S1+cisplatin) followed by radical gastrectomy with systematic PALN dissection for patients with clinically diagnosed metastasis to the PALNs (13). The R0 resection rate was 82% and the 5-year OS rate 57%. These 3685

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Section: Discussionmentioning

confidence: 93%

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Kaito

Kinoshita

Tokunaga

et al. 2017

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“…Carcinomatosis originating from ovarian, colorectal, gastric and pancreatic carcinomas is common, accounting for up to 19% of patients after curative resection of carcinoma and 23-29% of patients with gastric cancer. 1,2 Inflammatory leukocytes massively infiltrate human solid tumors 3 and actively interact with neoplastic cells. The composition and activation status of tumor-infiltrating leukocytes depend on the tumor type and stage as well as on the anatomic location.…”

Section: Introductionmentioning

confidence: 99%

Leukocytes recruited by tumor-derived HMGB1 sustain peritoneal carcinomatosis

et al. 2016

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The factors that determine whether disseminated transformed cells in vivo yield neoplastic lesions have only been partially identified. We established an ad hoc model of peritoneal carcinomatosis by injecting colon carcinoma cells in mice. Tumor cells recruit inflammatory leukocytes, mostly macrophages, and generate neoplastic peritoneal lesions. Phagocyte depletion via clodronate treatment reduces neoplastic growth. Colon carcinoma cells release a prototypic damage-associated molecular pattern (DAMP)/alarmin, High Mobility Group Box1 (HMGB1), which attracts leukocytes. Exogenous HMGB1 accelerates leukocyte recruitment, macrophage infiltration, tumor growth and vascularization. Lentiviral-based HMGB1 knockdown or pharmacological interference with its extracellular impair macrophage recruitment and tumor growth. Our findings provide a preclinical proof of principle that strategies based on preventing HMGB1-driven recruitment of leukocytes could be used for treating peritoneal carcinomatosis.

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“…Even though no clear benefit has so far been shown, some investigators have pursued a supposed optimum extent of surgical intervention, as in the recently reported evaluation of the possible benefits of extended D2(+) para-aortic lymphadenectomy in patients with potentially curatively resected gastric cancer 18,19,20,21,22,23,24 .…”

Section: Discussionmentioning

confidence: 99%

Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials

et al. 2008

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Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer. Meta-analysis of randomized clinical trials 1 Impacto da linfadenectomia ampliada na morbidade, mortalidade, recidiva e cinco anos de sobrevida após gastrectomia por câncer. Effect of a combination of medium chain triglycerides, linoleic acid, soy lecithin and vitamins A and E on wound healing in rats

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Comparison of Surgical Results of D2 Versus D3 Gastrectomy (Para-Aortic Lymph Node Dissection) for Advanced Gastric Carcinoma: A Multi-Institutional Study

Abstract: D3 gastrectomy might be beneficial in patients with advanced pN2 gastric cancer within the group with tumors measuring 50 to 100 mm. A randomized controlled trial of patients with 50- to 100-mm tumors should be performed to test the validity of this preliminary result.

Cited by 63 publications

References 10 publications

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Leukocytes recruited by tumor-derived HMGB1 sustain peritoneal carcinomatosis

Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials

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