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Gastric Cancer

, Volume 21, Issue 5, pp 853–863 | Cite as

Which method is more suitable for advanced gastric cancer with enlarged lymph nodes, laparoscopic radical gastrectomy or open gastrectomy?

  • Qi-Yue Chen
  • Chao-Hui Zheng
  • Ping Li
  • Jian-Wei Xie
  • Jia-Bin Wang
  • Jian-Xian Lin
  • Jun Lu
  • Long-Long Cao
  • Mi Lin
  • Ru-Hong Tu
  • Ze-Ning Huang
  • Ju-Li Lin
  • Chang-Ming Huang
Original Article
  • 289 Downloads

Abstract

Background

The oncologic outcome of laparoscopic radical gastrectomy (LG) with open radical gastrectomy (OG) for gastric cancer with preoperative enlarged lymph nodes (LNs) remains ambiguous.

Methods

The long-term outcomes of LG (n = 855) versus OG (n = 154) in gastric adenocarcinoma patients were analyzed retrospectively. Patients were stratified according to enlarged (> 10 mm) and small (≤ 10 mm) LNs (ELN and SLN) based on the long-axis diameter of the LNs.

Results

The violin plot indicates that the distribution of ELN size was similar between two groups. Survival curves demonstrated that the overall survival (OS) in LG is enhanced compared with OG (p = 0.034). A stratified analysis revealed that the OS was better in the LG group compared with the OG group for patients with ELNs (p = 0.038). In a forest map analysis, the actual 3-year OS rate for LG was significantly increased compared with OG in enlarged suprapancreatic LN (ESLNs) patients. Stratified analysis based on different diameters of ESLNs revealed that the actual 3-year OS and cancer-specific survival (CSS)rate for LG was significant increased compared to OG with a diameter from 1.0 to 1.9 cm for pII or pIII stage patients. However, the actual 3-year OS and CSS rate for LG was significantly reduced compared with OG when the size exceeded 2.5 cm.

Conclusions

For advanced gastric cancer with an ESLN diameter from 1.0 to 1.9 cm, LG could be chosen preferentially; nevertheless, LG is not safe if ESLN are > 2.5 cm.

Keywords

Gastric carcinoma Enlarged LN Lymphadenectomy Long-term outcome Suprapancreatic area 

Notes

Funding

Sponsored by National Key Clinical Specialty Discipline Construction program of China (No. [2012]649), Scientific and technological innovation joint capital Projects of Fujian Province (2016Y9031), General Project of Miaopu scientific research fund of Fujian Medical University (2015MP021), Youth Project of Fujian Provincial Health and Family Planning Commission (2016-1-41), Nature Fund Health Joint Fund Project of Fujian Province (2015J01464).

Compliance with ethical standards

Conflict of interest

None of the authors had any potential conflicts of interest, including relevant financial interests, activities, relationships, and affiliations.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients for being included in the study.

Supplementary material

10120_2018_800_MOESM1_ESM.tif (1 mb)
Supplementary material 1 The correlation between LNs size and pN stages. (TIFF 1056 kb)
10120_2018_800_MOESM2_ESM.docx (13 kb)
Supplementary material 2 (DOCX 12 kb)
10120_2018_800_MOESM3_ESM.docx (12 kb)
Supplementary material 3 (DOCX 12 kb)
10120_2018_800_MOESM4_ESM.docx (13 kb)
Supplementary material 4 (DOCX 13 kb)
10120_2018_800_MOESM5_ESM.tif (57 kb)
Supplementary material 5 Three years cancer-specific survival in different diameter of enlarged area II LNs between LG and OG.(A)pI stage (B)pII stage(C)pIII stage. (TIFF 56 kb)
10120_2018_800_MOESM6_ESM.docx (14 kb)
Supplementary material 6 (DOCX 14 kb)

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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Qi-Yue Chen
    • 1
    • 2
    • 3
    • 4
  • Chao-Hui Zheng
    • 1
    • 2
    • 3
    • 4
  • Ping Li
    • 1
    • 2
    • 3
    • 4
  • Jian-Wei Xie
    • 1
    • 2
    • 3
    • 4
  • Jia-Bin Wang
    • 1
    • 2
    • 3
    • 4
  • Jian-Xian Lin
    • 1
    • 2
    • 3
    • 4
  • Jun Lu
    • 1
    • 2
    • 3
    • 4
  • Long-Long Cao
    • 1
    • 2
    • 3
    • 4
  • Mi Lin
    • 1
    • 2
    • 3
    • 4
  • Ru-Hong Tu
    • 1
    • 2
    • 3
    • 4
  • Ze-Ning Huang
    • 1
    • 2
    • 3
    • 4
  • Ju-Li Lin
    • 1
    • 2
    • 3
    • 4
  • Chang-Ming Huang
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
  2. 2.Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
  3. 3.Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
  4. 4.Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina

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