Influence of Total Lymph Node Count on Staging and Survival After Gastrectomy for Gastric Cancer: An Analysis From a Two-Institution Database in China

Lü, Jun; Wang, Wei; Zheng, Chao; Fang, Cheng; Li, Ping; Xie, Jian; Wang, Jia Bin; Lin, Jian; Chen, Qi Yue; Cao, Long Long; Ma, Lin; Changming, Huang; Zhou, Zhi Wei

doi:10.1245/s10434-016-5494-7

Cited by 63 publications

(51 citation statements)

References 27 publications

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“…Moreover, the mean retrieved lymph nodes were comparable in two arms in our study (LADG vs. ODG: 29.5 ± 10.4 vs. 31.4 ± 12.3, P = 0.083), which was in the range of 23.0–43.3 as reported previously [6, 39, 40], but slightly less than that presented in CLASS-01 [14]. The number of harvested lymph nodes was not only associated with the surgical technique but also correlated with the thoroughness of pathological examination, state of specimens and the innate number of lymph nodes for each patient [39].…”

Section: Discussionsupporting

confidence: 88%

“…The number of harvested lymph nodes was not only associated with the surgical technique but also correlated with the thoroughness of pathological examination, state of specimens and the innate number of lymph nodes for each patient [39]. In China, experienced surgeons after learning curve could harvest 26.2–28.8 LNs in D2 lymphadenectomy [41, 42].…”

Section: Discussionmentioning

confidence: 99%

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Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

et al. 2018

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BackgroundAlthough laparoscopic surgery has been recommended as an optional therapy for patients with early gastric cancer, whether patients with locally advanced gastric cancer (AGC) could benefit from laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy remains elusive due to a lack of comprehensive clinical data. To evaluate the efficacy of LADG, we conducted a multi-institutional randomized controlled trial to compare laparoscopy-assisted versus open distal gastrectomy (ODG) for AGC in North China.MethodsIn this RCT, after patients were enrolled according to the eligibility criteria, they were preoperatively assigned to LADG or ODG arm randomly with a 1:1 allocation ratio. The primary endpoint was the morbidity and mortality within 30 postoperative days to evaluate the surgical safety of LADG. The secondary endpoint was 3-year disease-free survival. This trial was registered at ClinicalTrial.gov as NCT02464215.ResultsBetween March 2014 and August 2017, a total of 446 patients with cT2-4aN0-3M0 (AJCC 7th staging system) were enrolled. Of these, 222 patients underwent LADG and 220 patients underwent ODG were included in the modified intention-to-treat analysis. The compliance rate of D2 lymph node dissection was identical between the LADG and ODG arms (99.5%, P = 1.000). No significant difference was observed regarding the overall postoperative complication rate in two groups (LADG 13.1%, ODG 17.7%, P = 0.174). No operation-related death occurred in both arms.ConclusionsThis trial confirmed that LADG performed by credentialed surgeons was safe and feasible for patients with AGC compared with conventional ODG.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

et al. 2018

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“…A higher total harvested negative nodes or lower ratio of positive nodes, referred to as the Maruyama index, also saw improvements in both survival and progression free survival [5, 19, 58]. The Maruyama index was created to determine unresected disease as the sum of regional nodal disease, with higher value on the index portending poorer outcome [5, 19, 58].…”

Section: Introductionmentioning

confidence: 99%

“…The Maruyama index was created to determine unresected disease as the sum of regional nodal disease, with higher value on the index portending poorer outcome [5, 19, 58]. …”

Section: Introductionmentioning

confidence: 99%

“…Although stage migration alone cannot alone explain the differences in survival, there is perhaps the biology of the tumor in eastern countries [58]. When D2 dissection is carried out in the USA, comparison of patients to their Japanese and Korean cohorts initially showed similar survival to Japanese patients when controlled for tumor location [3, 59].…”

Section: Introductionmentioning

confidence: 99%

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Evolution in the surgical management of gastric cancer: is extended lymph node dissection back in vogue in the USA?

et al. 2017

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BackgroundGastric cancer remains a formidable treatment challenge. For decades, treatment consisted mostly of surgical intervention for this deadly disease. With improvements in the multi-disciplinary management of solid organ malignancies, the approach to this disease is being stepwise refined.Main bodyOne of the prevalent controversies in the surgical management of gastric cancer rests on the need for adequate harvesting of lymph nodes. For decades, lymph node dissection is regarded as a staging technique useful in only upstaging the disease. The adoption of D2 lymphadenectomy has been particularly slow to mature. But with prevailing data from Asia consistently demonstrating a survival benefit from lymphadenectomy, it calls into question the notion of lymphadenectomy as being solely a staging procedure.ConclusionsAs gastric resection techniques are being better defined in western countries and surgical morbidities lowered on its execution, D2 lymphadenectomy is becoming more accepted as the new standard in the management of gastric cancer.

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Short-term Outcomes of Robotic Gastrectomy vs Laparoscopic Gastrectomy for Patients With Gastric Cancer

et al. 2021

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IMPORTANCE Robotic gastrectomy (RG) for gastric cancer may be associated with decreased incidence of intra-abdominal infectious complications, including pancreatic fistula, leakage, and abscess. Prospective randomized clinical trials comparing laparoscopic gastrectomy (LG) and RG are thus required.OBJECTIVE To compare the short-term surgical outcomes of RG with those of LG for patients with gastric cancer. DESIGN, SETTING, AND PARTICIPANTSIn this phase 3, prospective superiority randomized clinical trial of RG vs LG regarding reduction of complications, 241 patients with resectable gastric cancer (clinical stages I-III) were enrolled between April 1, 2018, and October 31, 2020. INTERVENTIONSLG vs RG. MAIN OUTCOMES AND MEASURESThe primary end point was the incidence of postoperative intra-abdominal infectious complications. Secondary end points were incidence of any complications, surgical results, postoperative courses, and oncologic outcomes. The modified intention-to-treat population excluded patients who had been randomized and met the postrandomization exclusion criteria. There was also a per-protocol population for analysis of postoperative complications. RESULTSThis study enrolled 241 patients, with 236 patients in the modified intention-to-treat population (150 men [63.6%]; mean [SD] age, 70.8 [10.7] years). There was no significant difference in the incidence of intra-abdominal infectious complications (per-protocol population: 10 of 117 [8.5%] in the LG group vs 7 of 113 [6.2%] in the RG group). Of 241 patients, 122 were randomly assigned to the LG group, and 119 patients were randomly assigned to the RG group. Two of the 122 patients (1.6%) in the LG group converted from LG to open surgery, and 4 of 119 patients (3.4%) in the RG group converted from RG to open or laparoscopic surgery, with no significant difference. Finally, 117 patients in the LG group completed the procedure, and 113 in the RG group completed the procedure; these populations were defined as the per-protocol population. The overall incidence of postoperative complications of grade II or higher was significantly higher in the LG group (23 [19.7%]) than in the RG group (10 [8.8%]) (P = .02). Even in analysis limited to grade IIIa or higher, the complication rate was still significantly higher in the LG group (19 [16.2%]) than in the RG group (6 [5.3%]) (P = .01).CONCLUSIONS AND RELEVANCE This study found no reduction of intra-abdominal infectious complications with RG compared with LG for gastric cancer.TRIAL REGISTRATION umin.ac.jp/ctr Identifier: UMIN000031536

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Influence of Total Lymph Node Count on Staging and Survival After Gastrectomy for Gastric Cancer: An Analysis From a Two-Institution Database in China

Cited by 63 publications

References 27 publications

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

Evolution in the surgical management of gastric cancer: is extended lymph node dissection back in vogue in the USA?

Short-term Outcomes of Robotic Gastrectomy vs Laparoscopic Gastrectomy for Patients With Gastric Cancer

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