Skip to main content
SpringerLink
Log in

Left Gastric Artery Lymph Nodes Should Be Included in D1 Lymph Node Dissection in Gastric Cancer

  • 2017 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The Japanese Classification of Gastric Carcinoma includes the left gastric artery (#7) lymph nodes (LNs) in the recommended extent of D1 LN dissection, but this recommendation has not been validated in western institutions.

Methods

We reviewed data from a prospectively maintained database of gastric cancer patients who underwent resection at our academic cancer center and had a separate pathologic assessment of #7 LN in 2005–2016. Risk factors for #7 LN metastases and overall survival were examined by uni- and multivariable analyses.

Results

We identified 173 patients; 114 (66%) were treated with preoperative therapy, most commonly with chemoradiation therapy (47%, 81/173). We identified 22 patients (13%) who had #7 LN metastases, which accounted for 35% (22/63) of node-positive patients. No preoperative factors were associated with #7 LN metastases by univariable analyses. Patients with #7 metastases were not associated with shorter overall survival after adjustment by nodal stage (hazard ratio 1.49, 95% confidence interval 0.67–3.32; p = 0.33).

Conclusion

Metastasis to #7 LN station was common in gastric cancer, but the survival impact was not significant after adjustment by nodal stage. We conclude that #7 LNs should be routinely dissected in gastric cancer patients, and this station should be included within the extent of D1 LN dissection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sano T, Coit DG, Kim HH, Roviello F, Kassab P, Wittekind C et al. Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2017;20(2):217–25. doi:10.1007/s10120-016-0601-9.

    Article  Google Scholar 

  2. Galizia G, Lieto E, Auricchio A, Cardella F, Mabilia A, Diana A et al. Comparison of the current AJCC-TNM numeric-based with a new anatomical location-based lymph node staging system for gastric cancer: a western experience. PloS One. 2017;12(4):e0173619. doi:10.1371/journal.pone.0173619.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fleming ID CJ, Henson DE, Manual for Staging of Cancer (5th ed.). American Joint Committee on Cancer (AJCC). Philadelphia: Lippincott; 1997.

  4. Japanese Gastric Cancer A. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2011;14(2):101–12. doi:10.1007/s10120-011-0041-5.

    Article  Google Scholar 

  5. Karpeh MS, Leon L, Klimstra D, Brennan MF. Lymph node staging in gastric cancer: is location more important than Number? An analysis of 1,038 patients. Annals of Surgery. 2000;232(3):362–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Hayashi H, Ochiai T, Suzuki T, Shimada H, Hori S, Takeda A et al. Superiority of a new UICC-TNM staging system for gastric carcinoma. Surgery. 2000;127(2):129–35. doi:10.1067/msy.2000.102171.

    Article  CAS  PubMed  Google Scholar 

  7. de Manzoni G, Verlato G, Roviello F, Morgagni P, Di Leo A, Saragoni L et al. The new TNM classification of lymph node metastasis minimises stage migration problems in gastric cancer patients. British Journal of Cancer. 2002;87(2):171–4. doi:10.1038/sj.bjc.6600432.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fujii K, Isozaki H, Okajima K, Nomura E, Niki M, Sako S et al. Clinical evaluation of lymph node metastasis in gastric cancer defined by the fifth edition of the TNM classification in comparison with the Japanese system. The British Journal of Surgery. 1999;86(5):685–9. doi:10.1046/j.1365-2168.1999.01115.x.

    Article  CAS  PubMed  Google Scholar 

  9. Ichikura T, Tomimatsu S, Uefuji K, Kimura M, Uchida T, Morita D et al. Evaluation of the New American Joint Committee on Cancer/International Union against cancer classification of lymph node metastasis from gastric carcinoma in comparison with the Japanese classification. Cancer. 1999;86(4):553–8.

    Article  CAS  PubMed  Google Scholar 

  10. Ikoma N EJ, Blum MA, Chen HC, Wang X, Fournier KF, Mansfield PF, Ajani JA, Badgwell BD. Lymph node metastasis in gastric cancer: Location of positive station to predict survival after preoperative therapy. Gastrointestinal Cancers Symposium; San Francisco: Journal of Clinical Oncology 35, 2017 (suppl 4S; abstract 166) 166.

  11. Ajani JA, D'Amico TA, Almhanna K, Bentrem DJ, Chao J, Das P et al. Gastric Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/PDF/gastric.pdf. Accessed July 24th 2017.

  12. Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2017;20(1):1–19. doi: 10.1007/s10120-016-0622-4.

    Article  Google Scholar 

  13. Badgwell B, Ajani J, Blum M, Ho L, Fournier K, Chiang YJ et al. Postoperative morbidity and mortality rates are not increased for patients with gastric and gastroesophageal cancer who undergo preoperative chemoradiation therapy. Annals of Surgical Oncology. 2016;23(1):156–62. doi:10.1245/s10434-015-4643-8.

    Article  PubMed  Google Scholar 

  14. Badgwell B, Blum M, Estrella J, Chiang YJ, Das P, Matamoros A et al. Predictors of survival in patients with resectable gastric cancer treated with preoperative chemoradiation therapy and gastrectomy. Journal of the American College of Surgeons. 2015;221(1):83–90. doi:10.1016/j.jamcollsurg.2015.04.004.

    Article  PubMed  Google Scholar 

  15. Badgwell B, Blum M, Elimova E, Estrella J, Chiang YJ, Das P et al. Frequency of resection after preoperative chemotherapy or chemoradiotherapy for gastric adenocarcinoma. Annals of Surgical Oncology. 2016;23(6):1948–55. doi:10.1245/s10434-016-5112-8.

    Article  PubMed  Google Scholar 

  16. Ajani JA, D'Amico TA, Almhanna K, Bentrem DJ, Chao J, Das P et al. Gastric cancer, version 3.2016, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2016;14(10):1286–312.

    Article  PubMed  Google Scholar 

  17. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. The Lancet Oncology. 2010;11(5):439–49. doi:10.1016/S1470-2045(10)70070-X.

    Article  PubMed  Google Scholar 

  18. Degiuli M, Sasako M, Ponti A, Vendrame A, Tomatis M, Mazza C et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. The British Journal of Surgery. 2014;101(2):23–31. doi:10.1002/bjs.9345.

    Article  CAS  PubMed  Google Scholar 

  19. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. The British Journal of Surgery. 1995;82(3):346–51.

    Article  CAS  PubMed  Google Scholar 

  20. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. The New England Journal of Medicine. 2006;355(1):11–20. doi:10.1056/NEJMoa055531.

    Article  CAS  PubMed  Google Scholar 

  21. Ychou M, Boige V, Pignon JP, Conroy T, Bouche O, Lebreton G et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 2011;29(13):1715–21. doi:10.1200/JCO.2010.33.0597.

    Article  CAS  Google Scholar 

  22. Schuhmacher C, Gretschel S, Lordick F, Reichardt P, Hohenberger W, Eisenberger CF et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 2010;28(35):5210–8. doi:10.1200/JCO.2009.26.6114.

    Article  Google Scholar 

  23. Greenleaf EK, Hollenbeak CS, Wong J. Trends in the use and impact of neoadjuvant chemotherapy on perioperative outcomes for resected gastric cancer: evidence from the American College of Surgeons National Cancer Database. Surgery. 2016;159(4):1099–112. doi:10.1016/j.surg.2015.11.004.

    Article  PubMed  Google Scholar 

  24. Tsuburaya A, Mizusawa J, Tanaka Y, Fukushima N, Nashimoto A, Sasako M et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. The British Journal of Surgery. 2014;101(6):653–60. doi:10.1002/bjs.9484.

    Article  CAS  PubMed  Google Scholar 

  25. Yoshikawa T, Tanabe K, Nishikawa K, Ito Y, Matsui T, Kimura Y et al. Induction of a pathological complete response by four courses of neoadjuvant chemotherapy for gastric cancer: early results of the randomized phase II COMPASS trial. Annals of Surgical Oncology. 2014;21(1):213–9. doi:10.1245/s10434-013-3055-x.

    Article  PubMed  Google Scholar 

  26. Iwasaki Y, Sasako M, Yamamoto S, Nakamura K, Sano T, Katai H et al. Phase II study of preoperative chemotherapy with S-1 and cisplatin followed by gastrectomy for clinically resectable type 4 and large type 3 gastric cancers (JCOG0210). Journal of Surgical Oncology. 2013;107(7):741–5. doi:10.1002/jso.23301.

    Article  CAS  PubMed  Google Scholar 

  27. Leong T, Smithers BM, Michael M, Gebski V, Boussioutas A, Miller D et al. TOPGEAR: a randomised phase III trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer (an international, intergroup trial of the AGITG/TROG/EORTC/NCIC CTG). BMC Cancer. 2015;15:532. doi: 10.1186/s12885-015-1529-x.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Leong T, Smithers BM, Haustermans K, Michael M, Gebski V, Miller D et al. TOPGEAR: a randomized, phase III trial of perioperative ECF chemotherapy with or without preoperative chemoradiation for resectable gastric cancer: interim results from an international, intergroup trial of the AGITG, TROG, EORTC and CCTG. Annals of Surgical Oncology. 2017. doi:10.1245/s10434-017-5830-6.

  29. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual 8th edition. New York: Springer; 2017.

Download references

Acknowledgments

The authors would like to express their gratitude to Sunita Patterson, ELS, Department of Scientific Publications, University of Texas MD Anderson Cancer Center, for editorial assistance.

Funding

Supported in part by the NIH/NCI under award number P30CA016672 and used the Clinical Trials Support Resource.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA

    Naruhiko Ikoma, Keith F. Fournier, Paul F. Mansfield & Brian D. Badgwell

  2. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariela Blum & Jaffer A. Ajani

  3. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeannelyn S. Estrella

  4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Xuemei Wang

Authors
  1. Naruhiko Ikoma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariela Blum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeannelyn S. Estrella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xuemei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Keith F. Fournier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul F. Mansfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jaffer A. Ajani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brian D. Badgwell
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors (NI, MB, JSE, XW, KF, PM, JA, BDB) meet all of the following criteria:

- Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

- Drafting the work or revising it critically for important intellectual content; AND

- Final approval of the version to be published; AND

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Brian D. Badgwell.

Ethics declarations

Conflict of Interest

The authors have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ikoma, N., Blum, M., Estrella, J.S. et al. Left Gastric Artery Lymph Nodes Should Be Included in D1 Lymph Node Dissection in Gastric Cancer. J Gastrointest Surg 21, 1563–1570 (2017). https://doi.org/10.1007/s11605-017-3539-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-017-3539-2

Keywords

Search

Navigation