Abstract
Background
This study was intended to examine the safety of possibly incomplete dissection of lymph node stations (LNS) 5 and 6 in pylorus-preserving gastrectomy (PPG) for gastric cancer.
Materials and Methods
We reviewed the medical information from 1802 gastric cancer patients who underwent curative gastrectomy and whose lymph nodes were topographically classified according to LNS between March 2003 and December 2008. We divided the patients who underwent subtotal gastrectomy into 2 groups according to the distance between the distal resection margin (DRM) and primary tumor: those with a distance of <6 cm (the <6 DRM group) and those with a distance of ≥6 cm (the ≥6 DRM group). We analyzed the lymph node metastasis rate to LNS 5 and 6 according to T stage and the location. The number of retrieved lymph nodes according to LNS was compared between subtotal gastrectomy (STG) and PPG.
Results
The metastasis rate to LNS 5 was very rare in ≥6 DRM group: T1a, 0% (0 of 105); T1b, 0.9% (1 of 113); and T2a, 0% (0 of 56), although the number of retrieved LNS 5 was significantly lower in PPG than in STG. The metastasis rate to LNS 6 in the ≥6 DRM group was significantly lower than in the <6 DRM group, but higher than that of LNS 5: T1a, 0% (0 of 107); T1b, 1.8% (2 of 114); and T2a, 3.6% (2 of 56). The number of retrieved LNS 6 was not significantly different between STG and PPG.
Conclusions
PPG seems to be safe for early gastric cancer located ≥5 cm from the pylorus in terms of LNS 5 and 6.
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References
Kong SH, Park DJ, Lee HJ, Jung HC, Lee KU, Choe KJ, et al. Clinicopathologic features of asymptomatic gastric adenocarcinoma patients in Korea. Jpn J Clin Oncol. 2004;34:1–7.
Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery. 1967;61:838–45.
Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer. 2007;10:167–72.
Park do J, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008;32:1029–36.
Zhang D, Shimoyama S, Kaminishi M. Feasibility of pylorus-preserving gastrectomy with a wider scope of lymphadenectomy. Arch Surg. 1998;133:993–7.
Hotta T, Taniguchi K, Kobayashi Y, Johata K, Sahara M, Naka T, et al. Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer. Surg Today. 2001;31:774–9.
Shibata C, Shiiba KI, Funayama Y, Ishii S, Fukushima K, Mizoi T, Koyama K, et al. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg. 2004;28:857–61.
Japanese Gastric Cancer A. Japanese classification of gastric carcinoma. 2nd English edn. Gastric Cancer. 1998;1:10–24.
Sawai K, Takahashi T, Fujioka T, Minato H, Taniguchi H, Yamaguchi T. Pylorus-preserving gastrectomy with radical lymph node dissection based on anatomical variations of the infrapyloric artery. Am J Surg. 1995;170:285–8.
Tomita R, Fujisaki S, Tanjoh K. Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer. World J Surg. 2003;27:725–33.
Kodama M, Koyama K, Chida T, Arakawa A, Tur G. Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancer. World J Surg. 1995;19:456–60; discussion 61.
Nunobe S, Hiki N, Fukunaga T, Tokunaga M, Ohyama S, Seto Y, et al. Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg. 2007;31:2335–40.
Nakane Y, Michiura T, Inoue K, Sato M, Nakai K, Yamamichi K. Length of the antral segment in pylorus-preserving gastrectomy. Br J Surg. 2002;89:220–4.
Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995;82:346–51.
Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M. Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg. 2006;203:162–9.
Lu Y, Hoa Y, Jia S, Gao C. Experimental study of pylorus and pyloric vagus preserving gastrectomy. World J Surg. 1993;17:525–9.
Kodama M, Koyama K. Indications for pylorus preserving gastrectomy for early gastric cancer located in the middle third of the stomach. World J Surg. 1991;15:628–33; discussion 33–4.
Tokunaga M, Ohyama S, Hiki N, Fukunaga T, Yamada K, Sano, et al. Investigation of the lymphatic stream of the stomach in gastric cancer with solitary lymph node metastasis. World J Surg. 2009;33:1235–9.
Shimoyama S, Mafune K, Kaminishi M. Indications for a pylorus-preserving gastrectomy for gastric cancer with proper muscle invasion. Arch Surg. 2003;138:1235–9.
Tokunaga M, Hiki N, Fukunaga T, Ohyama S, Yamada K, Yamaguchi T. Better prognosis of T2 gastric cancer with preoperative diagnosis of early gastric cancer. Ann Surg Oncol. 2009;16:1514–9.
Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg. 2008;95:1131–5.
Acknowledgment
This study was supported by a research fund, Seoul National University Hospital. (04-2009-112).
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Kong, SH., Kim, J.W., Lee, HJ. et al. The Safety of the Dissection of Lymph Node Stations 5 and 6 in Pylorus-Preserving Gastrectomy. Ann Surg Oncol 16, 3252–3258 (2009). https://doi.org/10.1245/s10434-009-0646-7
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DOI: https://doi.org/10.1245/s10434-009-0646-7