Clinical significance of No. 10 and 11 lymph nodes posterior to the splenic vessel in D2 radical total gastrectomy: An observational study

Wei Wang, Wenjun Xiong, Zhiwei Liu, Lijie Luo, Yansheng Zheng, Ping Tan, Dechang Diao, Liaonan Zou, Jin Wan, Wei Wang, Wenjun Xiong, Zhiwei Liu, Lijie Luo, Yansheng Zheng, Ping Tan, Dechang Diao, Liaonan Zou, Jin Wan

Abstract

D2 lymphadenectomy is widely performed for advanced proximal gastric cancer, but complete dissection of No. 10 and 11 lymph nodes (LNs) is technically challenging, especially for those posterior to the splenic vessel. This study aimed to investigate the clinical significance of removing No. 10 and 11 LNs posterior to the splenic vessel in radical total gastrectomy. Between January 2013 and February 2015, 53 patients who underwent spleen-preserving D2 radical total gastrectomy were enrolled. While dissecting No. 10 and 11 LNs, we divided them into 2 parts, namely LNs anterosuperior and posterior to the splenic vessel, and the pathological data were reviewed. Sixteen patients underwent laparoscopy and 37 underwent laparotomy. No mortality was recorded. According to the pathological results, the TNM stages of the tumor were IIA in 11 patients (20.8%), IIB in 5 (9.4%), IIIA in 7 (13.2%), IIIB in 10 (18.9%), and IIIC in 20 (18.9%). The mean number of LNs retrieved was 30.3 ± 12.3. The sum of No. 10 and 11 LNs posterior to the splenic vessel was 59 and the mean number was 1.11 ± 1.47. One LN with metastasis was found in the special 59 regional LNs, and the metastasis rate was 1.9% (1/53). Concerning the low metastasis rate (1.9%) and difficult complete dissection of No. 10 and 11 LNs posterior to the splenic vessel, our initial analysis suggests that the rate of No. 10 and 11 LNs posterior to the splenic vessel metastasis was 1.9%, but further studies are needed to reveal its clinical significance in D2 radical total gastrectomy for advanced proximal gastric cancer.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Abridged general view. A, Anterior view; B, posterior view. a = Artery, v = vein.
Figure 2
Figure 2
A, Anterosuperior LNs of No. 11 and No. 10 dissection in laparoscopic surgery. B, Posterior LNs of No. 11 and No. 10 dissection in laparoscopic surgery. a = Artery, LN = lymph node, v = vein.
Figure 3
Figure 3
A, Anterosuperior LNs of No. 11 and No. 10 dissection in open surgery. B, Posterior LNs of No. 11 and No. 10 dissection in open surgery. a = Artery, LN = lymph node, v = vein.

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65:5–29.
    1. Falk J, Carstens H, Lundell L, et al. Incidence of carcinoma of the oesophagus and gastric cardia. Changes over time and geographical differences. Acta Oncol 2007; 46:1070–1074.
    1. Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011; 14:113–123.
    1. Maruyama K, Gunven P, Okabayashi K, et al. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg 1989; 210:596–602.
    1. Shiu MH, Papacristou DN, Kosloff C, et al. Selection of operative procedure for adenocarcinoma of the midstomach. Twenty years’ experience with implications for future treatment strategy. Ann Surg 1980; 192:730–737.
    1. Monig SP, Collet PH, Baldus SE, et al. Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol 2001; 76:89–92.
    1. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 2006; 93:559–563.
    1. Doglietto GB, Pacelli F, Caprino P, et al. Pancreas-preserving total gastrectomy for gastric cancer. Arch Surg 2000; 135:89–94.
    1. Wang W, Liu Z, Xiong W, et al. Totally laparoscopic spleen-preserving splenic hilum lymph nodes dissection in radical total gastrectomy: an omnibearing method. Surg Endosc 2016; 30:2030–2035.
    1. Japanese Gastric Cancer A. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14:101–112.
    1. Wang W, Luo L, Zheng Y, et al. Curettage and aspiration in splenic hilar lymph node dissection for spleen-preserving radical D2 gastrectomy. Chin J Cancer Res 2013; 25:471–473.
    1. Bang YJ, Kim YW, Yang HK, et al. Noh SH, investigators Ct. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 2012; 379:315–321.
    1. Nashimoto A, Yabusaki H, Matsuki A. The significance of splenectomy for advanced proximal gastric cancer. Int J Surg Oncol 2012; 2012:301530.
    1. Sasada S, Ninomiya M, Nishizaki M, et al. Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer. Anticancer Res 2009; 29:3347–3351.
    1. Bo T, Peiwu Y, Feng Q, et al. Laparoscopy-assisted vs. open total gastrectomy for advanced gastric cancer: long-term outcomes and technical aspects of a case-control study. J Gastrointest Surg 2013; 17:1202–1208.
    1. Guan G, Jiang W, Chen Z, et al. Early results of a modified splenic hilar lymphadenectomy in laparoscopy-assisted total gastrectomy for gastric cancer with stage cT1-2: a case-control study. Surg Endosc 2013; 27:1923–1931.
    1. Lin J, Huang C, Zheng C, et al. A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasion. Chin Med J (Engl) 2014; 127:403–407.
    1. Jia-Bin W, Chang-Ming H, Chao-Hui Z, et al. Laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer in left approach: a new operation procedure. World J Surg Oncol 2012; 10:241.
    1. Shin SH, Jung H, Choi SH, et al. Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer. Ann Surg Oncol 2009; 16:1304–1309.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel