Relevance of hepatoduodenal ligament lymph nodes in resectional surgery for gastric cancer

Lee, S L; Lee, H H; Ko, Yoon Ho; Song, Kyo Young; Park, C H; Jeon, Hae Myung; Kim, S S

doi:10.1002/bjs.9438

Cited by 13 publications

(14 citation statements)

References 19 publications

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“…Lee et al [14] reported that prognosis differed between patients with hepatoduodenal (No.12) LN metastasis and those with distant metastases. Similarly, in this study, survival outcomes were similar between cases of No.12a LN metastasis and those of LN involvement in the AJCC (7 th edition)-defined D2 lymphadenectomy region, although survival was poorer in cases of No.12a LN metastasis than in those of distant metastasis.…”

Section: Discussionmentioning

confidence: 99%

Survival of Proper Hepatic Artery Lymph Node Metastasis in Patients with Gastric Cancer: Implications for D2 Lymphadenectomy

Cai

Chen

et al. 2015

PLoS ONE

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Background and AimsThere is a discrepancy between the American Joint Committee on Cancer (AJCC) guidelines (7th edition) and the Japanese treatment guidelines (3rd edition) with regard to the extent of D2 lymphadenectomy for gastric cancer. In the AJCC, hepatic artery station (No.12a) lymph node (LN) metastasis is classified as distant metastasis, whereas in the Japanese guidelines, this classified is regional metastasis. This study aimed to evaluate whether it is appropriate to reclassify No.12a LN metastasis as distant metastasis in consideration of survival outcome.MethodsIn this retrospective analysis, data from patients with gastric cancer who underwent regular D2 or greater lymphadenectomy between 1996 and 2006 were evaluated to determine any association between the clinicopathological features of hepatic artery LNs and survival prognosis.ResultsAmong the 247 patients with gastric cancer who underwent No.12 LN harvest, 45 (18.2%) were positive for No.12a LN metastasis. No.12a LN metastasis was significantly associated with poor clinicopathological features, advanced tumor stage, and poor overall survival. The 5-year survival rate of patients with No.12a LN metastasis was significantly better than that of patients with distant metastasis (P < 0.05), but was similar to that of patients with LN involvement in the D2 lymphadenectomy region (P > 0.05). No.12a LN metastasis was shown to significantly influence survival outcome in univariate analysis, but was not identified as a significant independent predictor in multivariate analysis. In logistic multivariate regression analysis, T stage, N stage, and station No.3, 5, and 6 LN metastasis were independent predictors of No.12a LN involvement.ConclusionsIt is inappropriate to reclassify No.12a LN metastasis as distant metastasis. We propose that this be considered as regional metastasis and be included in the extent of D2 lymphadenectomy to improve survival outcomes in patients with gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Survival of Proper Hepatic Artery Lymph Node Metastasis in Patients with Gastric Cancer: Implications for D2 Lymphadenectomy

Cai

Chen

et al. 2015

PLoS ONE

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“…Several studies calculated the incidence of lymph node metastases in second level nodes, removed by D2 dissection. The rates of nodal metastasis in second-level nodes (8a, 10, 11p/d, 12a) range according to depth of invasion, histotype, tumor location and other pathological factors (9,(20)(21)(22)(23). It is evident that removing these metastatic nodes could favour an increase in surgical radicality.…”

Section: Removal Of Potentially Metastatic Nodes and Increase In Surgmentioning

confidence: 99%

Lymphadenectomy: state of the art

Marrelli

Franco

Iudici

et al. 2017

Transl. Gastroenterol. Hepatol.

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The extent of lymphadenectomy in gastric cancer (GC) surgery has been for long time a matter of debate. Randomized trials performed in the West reported worse results of D2 dissection, in terms of postoperative complications and long-term survival benefit, than Eastern series and observational studies from specialized Western centers. However, long-term re-evaluation of such trials and in depth-analysis of other experiences demonstrated the potential benefit of D2 in reducing the probability of cancer-related death and the safety of this procedure when avoiding unnecessary spleno-pancreatectomy and in centers with ad adequate surgical volume. Nowadays, the D2 is considered the standard treatment in most guidelines all over the world. More limited procedures (D1, D1 plus) may be adequate in selected cases, and more extended dissections (D2 plus) could be indicated in advanced forms with high risk of metastases to distant nodes, but in specialized centers or in the setting of clinical studies. The integration with neoadjuvant therapies and multimodality approach could offer a chance of cure in groups of patients with poor results when approached with standard treatment.

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“…Analyzing the data of 1872 patients, LN involvement in station no.12 was 3.6% whereas HDLN metastasis was not a significant factor for survival in multivariate analysis and the 5year survival rate of 41 patients with HDLN metastasis without distant metastasis at any other site was significantly higher than that among 120 patients with stage Ⅳ disease without HDLN metastasis. It is suggested that the inclusion of HDLN in the distant metastatic LN group in gastric cancer is inappropriate and that the seventh American Joint Committee on Cancer criteria for node grouping should be revised [56] . The incidence of no.…”

Section: Middle and Distal Gastric Cancermentioning

confidence: 99%

Clinical significance of lymphadenectomy in patients with gastric cancer

Tóth

Plósz

Török

2016

WJGO

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Approximately thirty percent of patients with gastric cancer undergo an avoidable lymph node dissection with a higher rate of postoperative complication. Comparing the D1 and D2 dissections, it was found that there is a significant difference in morbidity, favoured D1 dissection without any difference in overall survival. Subgroup analysis of patients with T3 tumor shows a survival difference favoring D2 lymphadenectomy, and there is a better gastric cancer-related death and non-statistically significant improvement of survival for node-positive disease in patients with D2 dissection. However, the extended lymphadenectomy could improve stage-specific survival owing to the stage migration phenomenon. The deployment of centralization and application of national guidelines could improve the surgical outcomes. The Japanese and European guidelines enclose the D2 lymphadenectomy as the gold standard in R0 resection. In the individualized, stageadapted gastric cancer surgery the Maruyama computer program (MCP) can estimate lymph node involvement preoperatively with high accuracy and in addition the Maruyama Index less than 5 has a better impact on survival, than D-level guided surgery. For these reasons, the preoperative application of MCP is recommended routinely, with an aim to perform "low Maruyama Index surgery". The sentinel lymph node biopsy (SNB) may decrease the number of redundant lymphadenectomy intraoperatively with a high detection rate (93.7%) and an accuracy of 92%. More accurate stage-adapted surgery could be performed using the MCP and SNB in parallel fashion in gastric cancer.

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Relevance of hepatoduodenal ligament lymph nodes in resectional surgery for gastric cancer

Abstract: It is inappropriate to include the HDLN in the distant metastatic lymph node group in gastric cancer. The seventh AJCC criteria for node grouping should be revised.

Cited by 13 publications

References 19 publications

Survival of Proper Hepatic Artery Lymph Node Metastasis in Patients with Gastric Cancer: Implications for D2 Lymphadenectomy

Survival of Proper Hepatic Artery Lymph Node Metastasis in Patients with Gastric Cancer: Implications for D2 Lymphadenectomy

Lymphadenectomy: state of the art

Clinical significance of lymphadenectomy in patients with gastric cancer

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