1. Reappraise role of No. 10 lymphadenectomy for proximal gastric cancer in the era of minimal invasive surgery during total gastrectomy: a pooled analysis of 4 prospective trial
- Author
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Ziyu Li, Zekuan Xu, Wen-Bin Zhang, Yan-Chang Xu, Lisheng Cai, Chao-Hui Zheng, Qi-Yue Chen, Ping Li, Xiangqian Su, Peiwu Yu, Chang-Ming Huang, Jiafu Ji, Lin Fan, Fangqin Xue, Yihong Sun, Yong Li, Jian-Wei Xie, Guoxin Li, Jun You, Qing Zhong, Jin Wan, Su Yan, Gang Zhao, Dong-Po Xu, Jiankun Hu, and Zu-Guang Wu
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Surgical oncology ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,Neoplasm Invasiveness ,Prospective Studies ,education ,Propensity Score ,education.field_of_study ,Clinical Trials as Topic ,business.industry ,Incidence ,Gastroenterology ,General Medicine ,Middle Aged ,medicine.disease ,Curvatures of the stomach ,Surgery ,Intention to Treat Analysis ,Dissection ,Oncology ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Feasibility Studies ,Lymph Node Excision ,030211 gastroenterology & hepatology ,Lymphadenectomy ,Female ,Laparoscopy ,business ,Organ Sparing Treatments ,Spleen ,Abdominal surgery - Abstract
For patients with locally advanced proximal gastric cancer (LAPGC), the individualized selection of patients with highly suspected splenic hilar (No. 10) lymph node (LN) metastasis to undergo splenic hilar lymphadenectomy, is a clinical dilemma. This study aimed to re-evaluate the feasibility and safety of laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) and to identify the population who would benefit from it. A total of 1068 patients (D2 group = 409; D2 + No. 10 group = 659) who underwent laparoscopic total gastrectomy from four prospective trials between January 2015 and July 2019 were analyzed. No significant difference in the incidence (16.9% vs. 16.4%; P = 0.837) of postoperative complications were found between the two groups. The metastasis rate of No. 10 LN among patients in the D2 + No. 10 group was 10.3% (68/659). Based on the decision tree, patients with LAPGC with tumor invading the greater curvature (Gre), patients with non-Gre-invading LAPGC with a tumor size > 5 cm and clinical positive locoregional LNs were defined as the high-priority No. 10 dissection group. The metastasis rate of No. 10 LNs in the high-priority group was 19.4% (41/211). In high-priority group, the 3-year overall survival of the D2 + No. 10 group was better than that of the D2 group (74.4% vs. 42.1%; P = 0.005), and the therapeutic index of No. 10 was higher than the indices of most suprapancreatic stations. LSPSHL for LAPGC is safe and feasible when performed by experienced surgeons. LSPSHL could be recommended for the high-priority group patients even without invasion of the Gre.
- Published
- 2020