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Short-term outcomes of D2 lymphadenectomy plus complete mesogastric excision for gastric cancer: a propensity score matching analysis

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Abstract

Background

Our previous study has demonstrated the surgical advantages of D2 lymphadenectomy plus complete mesogastric excision (D2 + CME) in gastric cancer surgery. To further verify the safety of D2 + CME procedure, we conducted this large-scale, observational cohort study and applied propensity score matching (PSM) approach to compare D2 + CME with conventional D2 in terms of short-term outcomes in gastric cancer patients.

Methods

Data on 855 patients from Tongji Hospital who underwent laparoscopic-assisted distal gastrectomy (LADG) with R0 resection (496 in the conventional D2 cohort and 359 in the D2 + CME cohort) between Dec 12, 2013 and Dec 28, 2017 were retrieved from prospectively maintained clinical database. After PSM analysis at a 1:1 ratio, each cohort included 219-matched patients. Short-term outcomes, including surgical results, morbidity, and mortality within 30 days after the operation, were collected and analyzed.

Results

In this large-scale, observational cohort study based on PSM analysis, the D2 + CME procedure showed less intra-laparoscopic blood loss, more lymph node harvest, and faster postoperative flatus than the conventional D2 procedure. However, both the overall and severe postoperative adverse events (Clavien–Dindo classification grade ≥ III a) seemed comparable between two cohorts.

Conclusion

The present study showed that D2 + CME was associated with better short-term outcomes than conventional D2 dissection for patients with resectable gastric cancer.

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References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108. https://doi.org/10.3322/caac.21262

    Article  PubMed  Google Scholar 

  2. Sasako M, Saka M, Fukagawa T, Katai H, Sano T (2007) Surgical treatment of advanced gastric cancer: Japanese perspective. Dig Surg 24(2):101–107. https://doi.org/10.1159/000101896

    Article  CAS  PubMed  Google Scholar 

  3. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123. https://doi.org/10.1007/s10120-011-0042-4

    Article  Google Scholar 

  4. Giacopuzzi S, Bencivenga M, Cipollari C, Weindelmayer J, de Manzoni G (2017) Lymphadenectomy: how to do it? Transl Gastroenterol Hepatol 2:28. https://doi.org/10.21037/tgh.2017.03.09

    Article  PubMed  PubMed Central  Google Scholar 

  5. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg 69(10):613–616. https://doi.org/10.1002/bjs.1800691019

    Article  CAS  PubMed  Google Scholar 

  6. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482. https://doi.org/10.1016/s0140-6736(86)91510-2

    Article  CAS  PubMed  Google Scholar 

  7. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis 11(4):354–365. https://doi.org/10.1111/j.1463-1318.2008.01735.x

    Article  CAS  PubMed  Google Scholar 

  8. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28(2):272–278. https://doi.org/10.1200/JCO.2009.24.1448

    Article  PubMed  Google Scholar 

  9. Siani LM, Garulli G (2017) The importance of the mesofascial interface in complete mesocolic excision. Surgeon 15(4):240–249. https://doi.org/10.1016/j.surge.2016.10.006

    Article  PubMed  Google Scholar 

  10. Kim NK, Kim YW, Han YD et al (2016) Complete mesocolic excision and central vascular ligation for colon cancer: principle, anatomy, surgical technique, and outcomes. Surg Oncol 25(3):252–262. https://doi.org/10.1016/j.suronc.2016.05.009

    Article  PubMed  Google Scholar 

  11. Xie D, Osaiweran H, Liu L et al (2013) Mesogastrium: a fifth route of metastasis in gastric cancer? Med Hypotheses 80(4):498–500. https://doi.org/10.1016/j.mehy.2012.12.020

    Article  PubMed  Google Scholar 

  12. Xie D, Liu L, Osaiweran H et al (2015) Detection and characterization of metastatic cancer cells in the mesogastrium of gastric cancer patients [published correction appears in PLoS One. 2016;11(1):e0148681]. PLoS ONE 10(11):e0142970. https://doi.org/10.1371/journal.pone.0142970

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Xie D, Gao C, Lu A et al (2015) Proximal segmentation of the dorsal mesogastrium reveals new anatomical implications for laparoscopic surgery. Sci Rep 5:16287. https://doi.org/10.1038/srep16287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Xie D, Yu C, Liu L et al (2016) Short-term outcomes of laparoscopic D2 lymphadenectomy with complete mesogastrium excision for advanced gastric cancer. Surg Endosc 30(11):5138–5139. https://doi.org/10.1007/s00464-016-4847-4

    Article  PubMed  Google Scholar 

  15. Cao B, Xiao A, Shen J, Xie D, Gong J (2020) An optimal surgical approach for suprapancreatic area dissection in laparoscopic D2 gastrectomy with complete mesogastric excision. J Gastrointest Surg 24(4):916–917. https://doi.org/10.1007/s11605-019-04467-8

    Article  PubMed  Google Scholar 

  16. Xie D, Wang Y, Shen J, Hu J, Yin P, Gong J (2018) Detection of carcinoembryonic antigen in peritoneal fluid of patients undergoing laparoscopic distal gastrectomy with complete mesogastric excision. Br J Surg 105(11):1471–1479. https://doi.org/10.1002/bjs.10881

    Article  CAS  PubMed  Google Scholar 

  17. Shen J, Cao B, Wang Y et al (2018) Prospective randomized controlled trial to compare laparoscopic distal gastrectomy (D2 lymphadenectomy plus complete mesogastrium excision, D2 + CME) with conventional D2 lymphadenectomy for locally advanced gastric adenocarcinoma: study protocol for a randomized controlled trial. Trials 19(1):432. https://doi.org/10.1186/s13063-018-2790-5

    Article  PubMed  PubMed Central  Google Scholar 

  18. Xie D, Shen J, Liu L et al (2021) Complete mesogastric excision for locally advanced gastric cancer: short-term outcomes of a randomized clinical trial. Cell Rep Med 2(3):100217. https://doi.org/10.1016/j.xcrm.2021.100217

    Article  PubMed  PubMed Central  Google Scholar 

  19. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of adverse events of surgery with examples of utility in cholecystectomy. Surgery 111(5):518–526

    CAS  PubMed  Google Scholar 

  20. Hu Y, Huang C, Sun Y et al (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34(12):1350–1357. https://doi.org/10.1200/JCO.2015.63.7215

    Article  PubMed  Google Scholar 

  21. Lee HJ, Hyung WJ, Yang HK et al (2019) Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 270(6):983–991. https://doi.org/10.1097/SLA.0000000000003217

    Article  PubMed  Google Scholar 

  22. Inaki N, Etoh T, Ohyama T et al (2015) A multi-institutional, prospective, Phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39(11):2734–2741. https://doi.org/10.1007/s00268-015-3160-z

    Article  PubMed  Google Scholar 

  23. Smith DD, Schwarz RR, Schwarz RE (2005) Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol 23(28):7114–7124. https://doi.org/10.1200/JCO.2005.14.621

    Article  PubMed  Google Scholar 

  24. Baxter NN, Tuttle TM (2005) Inadequacy of lymph node staging in gastric cancer patients: a population-based study. Ann Surg Oncol 12(12):981–987. https://doi.org/10.1245/ASO.2005.03.008

    Article  PubMed  Google Scholar 

  25. Li B, Li Y, Wang W et al (2016) Incorporation of N0 stage with insufficient numbers of lymph nodes into N1 stage in the seventh edition of the TNM classification improves prediction of prognosis in gastric cancer: results of a single-institution study of 1258 Chinese patients. Ann Surg Oncol 23(1):142–148. https://doi.org/10.1245/s10434-015-4578-0

    Article  PubMed  Google Scholar 

  26. Shinohara T, Satoh S, Kanaya S et al (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27(1):286–294. https://doi.org/10.1007/s00464-012-2442-x

    Article  PubMed  Google Scholar 

  27. Yu J, Hu J, Huang C et al (2013) The impact of age and comorbidity on postoperative adverse events in patients with advanced gastric cancer after laparoscopic D2 gastrectomy: results from the Chinese laparoscropic gastrointestinal surgery study (CLASS) cohort. Eur J Surg Oncol 39(10):1144–1149. https://doi.org/10.1016/j.ejso.2013.06.021

    Article  CAS  PubMed  Google Scholar 

  28. Yu HW, Jung DH, Son SY et al (2013) Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery. J Gastric Cancer 13(3):179–184. https://doi.org/10.5230/jgc.2013.13.3.179

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kim MC, Kim W, Kim HH et al (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol 15(10):2692–2700. https://doi.org/10.1245/s10434-008-0075-z

    Article  PubMed  Google Scholar 

  30. Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS (2008) The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 248(5):793–799. https://doi.org/10.1097/SLA.0b013e3181887516

    Article  PubMed  Google Scholar 

  31. Etoh T, Shiraishi N, Tajima M et al (2007) Transient liver dysfunction after laparoscopic gastrectomy for gastric cancer patients. World J Surg 31(5):1115–1120. https://doi.org/10.1007/s00268-007-0237-3

    Article  PubMed  Google Scholar 

  32. Kim CH, Song KY, Park CH, Seo YJ, Park SM, Kim JJ (2015) A comparison of outcomes of three reconstruction methods after laparoscopic distal gastrectomy. J Gastric Cancer 15(1):46–52. https://doi.org/10.5230/jgc.2015.15.1.46

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank Professor Fanbiao Kong and Yujie Zhang for the assistance with Propensity Score Matching.

Funding

This work was supported by the National Natural Science Foundation of China (Grants 81372324 and 81874185).

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    Dayong Zhao, Jiao Deng, Jie Shen, Liang Liu, Aitang Xiao, Daxing Xie & Jianping Gong

  2. Department of Thyroid and Breast Surgery, People’s Hospital of Henan Province, Zhengzhou, 450003, China

    Beibei Cao

  3. Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    Ping Yin

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  1. Dayong Zhao
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Contributions

J.G. and D.X. designed the study. D.Z., J.D., and B.C. extracted and collected data. D.Z., J.S., L.L., A.X., and D.X. analyzed and interpreted the data. D.Z. drafted the manuscript. P.Y., D.X., and J.G. critically revised the manuscript.

Corresponding authors

Correspondence to Daxing Xie or Jianping Gong.

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Disclosures

Ping Yin and Drs. Dayong Zhao, Jiao Deng, Beibei Cao, Jie Shen, Liang Liu, Aitang Xiao, Daxing Xie, and Jianping Gong have no conflicts of interest or financial ties to disclose. None of the authors have financial relationships with any pharmaceutical or device company.

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Zhao, D., Deng, J., Cao, B. et al. Short-term outcomes of D2 lymphadenectomy plus complete mesogastric excision for gastric cancer: a propensity score matching analysis. Surg Endosc 36, 5921–5929 (2022). https://doi.org/10.1007/s00464-022-09092-2

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