Signature and Prediction of Perigastric Lymph Node Metastasis in Patients with Gastric Cancer and Total Gastrectomy: Is Total Gastrectomy Always Necessary?

Abstract

Background: A growing number of studies suggest that the current indications for partial gastrectomy, including proximal gastrectomy and pylorus-preserving gastrectomy (PPG), may be expanded, but evidence is still lacking. Methods: We retrospectively analyzed 300 patients with gastric cancer (GC) who underwent total gastrectomy. We analyzed the incidence of pLNMs in relation to tumor location, tumor size and T stage. We further identified predictive factors for perigastric lymph node metastasis (pLNM) in stations 1, 2, 3, 4sa, 4sb, 4d, 5, and 6. Results: No patients with upper-third T1–T2 stage GC had pLNMs in stations 4sa, 4sb, 4d, 5, or 6, but 3.8% of patients with stage T3 had 4d pLNM. No patients with upper-third GC < 4 cm in diameter had pLNMs in 2, 4sa, 4d, 5, or 6, and 2.3% of patients had pLNMs in 4sb. For middle-third GCs, 2.9% of patients with T1 stage had pLNMs in 4sa and 5, but no patients with T2 stage or tumors < 4 cm had pLNMs in 2, 4sa, or 5. The shortest distance from pylorus ring to distal edge of tumor (sDPD) was a new predictive factor for pLNMs in 2, 4d, 5, and 6. Conclusions: Proximal gastrectomy may be expanded to patients with stage T1–T2 GC and/or tumor diameter < 4 cm in the upper-third stomach, whereas PPG may be expanded to include T1–T2/N0 and/or tumors < 4 cm in the middle-third stomach. A new predictive factor, sDPD, showed good predictive performance for pLNMs, especially in stations 4d, 5, and 6.

Double-tract vs gastric tube reconstruction after proximal gastrectomy in upper third gastric cancer: a Propensity Score Matching Analysis

“…Yura [20] et al reported a pathological study of 202 patients with T2/T3 proximal gastric cancer who underwent TG showed that The metastatic rates at Nos.4d and Nos.12a were very low (0.99% and 0.006%, respectively), and those at Nos.5 and Nos.6 were zero. Therefore, PG with D1 + lymph node dissection for proximal early gastric cancer is an oncologically safe option [21] . There is no absolute requirement for preservation of the vagus nerve [22] , but when the vagus nerve around the esophagus is cut, it may cause pyloric spasm and dysfunction [14] , and preservation of the hepatic branch of the vagus nerve helps to reduce the occurrence of delayed gastric emptying [23] .…”