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Journal of Gastrointestinal Surgery

, Volume 20, Issue 7, pp 1295–1304 | Cite as

The Role of No. 10 Lymphadenectomy for Advanced Proximal Gastric Cancer Patients Without Metastasis to No. 4sa and No. 4sb Lymph Nodes

  • Shibo Bian
  • Hongqing Xi
  • Xiaosong Wu
  • Jianxin Cui
  • Liangang Ma
  • Rong Chen
  • Bo Wei
  • Lin ChenEmail author
Original Article

Abstract

Background

There is no consensus in the impact of No. 10 lymph node dissection (LND) for advanced proximal gastric cancer (APGC) and the status of negative No. 4sa and No. 4sb lymph nodes (No. 4s LNs) is reportedly associated with no metastasis to No. 10 LN. We aimed to evaluate the role of No. 10 LND in APGC patients with negative No. 4s LNs and the diagnostic accuracy of intraoperative pathologic examination.

Methods

We analyzed data on 727 patients with APGC who had undergone D2 lymphadenectomy with No. 10 LND (n = 380) or without No. 10 LND (n = 347) between January 2005 and December 2010. Additionally, from January to July 2014, we prospectively enrolled 48 patients with APGC and examined their No. 4s LNs intraoperatively.

Results

The negative predictive efficacy of No. 4s LN status for no metastasis to No. 10 LN was 98.09 %. Operation time, blood loss, time to first solid diet, hospital stay, and postoperative complication rate differed significantly between patients with negative No. 4s LNs who underwent No. 10 LND (n = 260) and those who did not undergo No. 10 LND (n = 243). Differences between the two groups in 5-year overall and disease-free survival were not statistically significant. The sensitivity, specificity, and accuracy of intraoperative pathological examination of LNs were 93.42, 96.56, and 95.86 %, respectively.

Conclusions

The No. 10 lymphadenectomy may not be recommended in patients with APGC who are found by intraoperative pathological examination to have negative No. 4s LNs.

Keywords

Advanced proximal gastric cancer No. 10 lymphadenectomy Intraoperative pathological examination Prognosis 

Abbreviations

APGC

Advanced proximal gastric cancer

No. 4s

No. 4sa and No. 4sb

H&E

Hematoxylin and eosin

IHC

Immunohistochemistry

ITC

Isolated tumor cells

LN

Lymph node

LND

Lymph node dissection

PBS

Phosphate-buffered saline

PGC

Proximal gastric cancer

Notes

Acknowledgments

The authors thank Mrs. Yaqi Ma and Fengwei Zhu for their work in the intraoperative pathological examination of lymph nodes.

Compliance with Ethical Standards

This study was performed in accordance with the Helsinki Declaration and was approved by the Institutional Review Board of the Chinese People’s Liberation Army General Hospital (S2013-116-01). Written informed consent was provided by all patients.

Grant support

None declared.

Permissions

None declared.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Shibo Bian
    • 1
  • Hongqing Xi
    • 1
  • Xiaosong Wu
    • 1
  • Jianxin Cui
    • 1
  • Liangang Ma
    • 1
  • Rong Chen
    • 1
  • Bo Wei
    • 1
  • Lin Chen
    • 1
    Email author
  1. 1.Department of General SurgeryChinese People’s Liberation Army General HospitalBeijingChina

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