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Pattern of Lymph Node Involvement in Proximal Gastric Cancer

World Journal of Surgery volume 33, Article number: 1687 (2009) Cite this article

Abstract

Background

The operative methods for proximal gastric cancer differ depending on the institution, thus there is no optimal therapeutic strategy. A splenic hilum lymph node (No. 10) dissection is necessary for D2 operation for proximal gastric cancer, which means it requires splenectomy. However, unnecessary splenectomy should be avoided.

Methods

A total of 127 proximal gastric cancer cases from our institution were studied retrospectively. In addition, 1,569 cases were collected from the literature and were used as pooled data for further analysis. All cases were examined for the depth of tumor invasion and lymph node metastasis.

Results

A retrospective analysis revealed that proximal gastric cancer within submucosa (40 cases) had no N2 lymph node metastasis in our study. The 5-year overall survival of all cases was 25.2% and the disease-free survival was 23.6%. From the pooled data analysis, No. 10 lymph node metastasis was observed in 0.9% of the patients with submucosa proximal gastric cancer. Furthermore, there was no No. 4d lymph node metastasis when the depth of cancer was limited to within the subserosa.

Conclusions

Although a randomized, controlled trial concerning survival is necessary, according to this study, there is a possibility that limited resection might be accepted for proximal gastric cancer according to the depth of wall invasion.

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References

  1. Shimada S, Yagi Y, Shiomori K et al (2001) Characterization of early gastric cancer and proposal of the optimal therapeutic strategy. Surgery 129:714–719

    PubMed  Article  CAS  Google Scholar 

  2. McCulloch P, Nita ME, Gama-Rodrigues J et al (2004) Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev 4:CD001964

    PubMed  Google Scholar 

  3. Hartgrink HH, van de Velde CJ, Putter H et al (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22:2069–2077

    PubMed  Article  CAS  Google Scholar 

  4. Japanese Gastric Cancer Association (1999) Japanese classification of gastric carcinoma, 13th edn. Kanahara Publisher, Tokyo

    Google Scholar 

  5. Maruyama K, Gunven P, Okababayashi K et al (1989) Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg 210:596–602

    PubMed  Article  CAS  Google Scholar 

  6. Isozaki H, Okajima K, Yamada S et al (1995) Proximal subtotal gastrectomy for the treatment of carcinoma of the upper third of the stomach: its indications based on lymph node metastasis and perigastric lymphatic flow. Surg Today 25:21–26

    PubMed  Article  CAS  Google Scholar 

  7. Sakaguchi T, Watanabe A, Sawada H et al (1998) Characteristics and clinical outcome of proximal-third gastric cancer. J Am Coll Surg 187:352–357

    PubMed  Article  CAS  Google Scholar 

  8. Kosaka T, Ueshige N, Sugaya J et al (1999) Lymphatic route of the stomach demonstrated by gastric carcinomas with solitary lymph node metastasis. Surg Today 26:695–700

    Article  Google Scholar 

  9. Nakamura K, Morisaki T, Sugitani A et al (1999) An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis. Cancer 85:1500–1505

    PubMed  Article  CAS  Google Scholar 

  10. Hochwald SN, Brennan MF, Klimstra DS et al (1999) Is lymphadenectomy necessary for early gastric cancer? Ann Surg Oncol 6:664–670

    PubMed  Article  CAS  Google Scholar 

  11. Kunisaki C, Shimada H, Nomura M et al (2001) Appropriate lymph node dissection for early gastric cancer based on lymph node metastases. Surgery 129:153–157

    PubMed  Article  CAS  Google Scholar 

  12. Yoshikawa T, Tsuburaya A, Kobayashi O et al (2002) Is D2 lymph node dissection necessary for early gastric cancer? Ann Surg Oncol 9:401–405

    PubMed  Article  Google Scholar 

  13. Kasakura Y, Mochizuki F, Wakabayashi K et al (2002) Gastric cancer: a retrospective study of 1403 cases at a single institution. J Surg Res 103:252–259

    PubMed  Article  Google Scholar 

  14. Hiraizumi N (2002) Evaluation of early gastric cancer operation cases; proximal gastric cancer. J Iwate Pref Hosp 42:89–93

    Google Scholar 

  15. Kunisaki C, Akiyama H, Nomura M et al (2005) Surgical outcomes for early gastric cancer in the upper third of the stomach. J Am Coll Surf 200:15–19

    Article  Google Scholar 

  16. Lee KY, Noh SH, Hyung WJ et al (2001) Impact of splenectomy for lymph node dissection on long-term surgical outcome in gastric cancer. Ann Sug Oncol 8:402–406

    Article  Google Scholar 

  17. Ohno M, Nakamura T, Ajiki T et al (2003) Procedure for lymph node dissection around splenic artery in proximal gastric cancer. Hepatogastroenterology 50:1173–1177

    PubMed  Google Scholar 

  18. Takeshita K, Saito N, Saeki I et al (1997) Proximal gastrectomy and jejunal pouch interposition for the treatment of early cancer in the upper third of the stomach: surgical techniques and evaluation of postoperative function. Surgery 121:278–286

    PubMed  Article  CAS  Google Scholar 

  19. Kitamura K, Nishika S, Yamamoto K et al (1998) Lymph node metastasis in gastric cancer in the upper third of the stomach: surgical treatment on the basis of the anatomical distribution of positive node. Hepatogastroenterology 45:281–285

    PubMed  CAS  Google Scholar 

  20. Takafuji K, Takeda H, Aoyagi K et al (2001) Evaluation of proximal gastric cancer cases. Jpn J Gastroenterol Surg 34:527–531

    Google Scholar 

  21. Nomura H, Ohyama S, Ohta K et al (2000) Evaluation of splenic hilum lymph node dissection against advanced upper gastric cancer. Jpn J Gastroenterol Surg 22:1609–1614

    Google Scholar 

  22. Kodera Y, Yamamura Y, Shimizu Y et al (1997) Surgical treatment of early cancer of the proximal third of the stomach. Eur Surg Res 29:303–310

    PubMed  Article  CAS  Google Scholar 

  23. Higashi H, Natsugoe S, Ishigami S et al (2003) Distribution of lymph node metastasis including micrometastasis in gastric cancer with submucosal invasion. World J Surg 27:455–459

    PubMed  Article  Google Scholar 

  24. Yasutake T, Tanaka K, Hidaka S et al (2002) J Japan Surg Assoc (meeting abstract) 63:785

    Google Scholar 

  25. Kitamura K, Yamaguchi T, Nishida S et al (1997) The operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach. Surg Today 27:993–998

    PubMed  Article  CAS  Google Scholar 

  26. Kitamura K, Yamaguchi T, Taniguchi H et al (1997) Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol 64:42–47

    PubMed  Article  CAS  Google Scholar 

  27. Sakaguchi T, Sawada H, Yamada Y et al (2001) Indication of splenectomy for gastric carcinoma involving the proximal part of the stomach. Hepatogastroenterology 48:603–605

    PubMed  CAS  Google Scholar 

  28. Erturk S, Ersan Y, Cicek Y et al (2003) Effect of simultaneous splenectomy on the survival of patients undergoing curative gastrectomy of proximal gastric carcinoma. Surg Today 33:254–258

    PubMed  Article  Google Scholar 

  29. Monig SP, Collet PH, Baldus SE et al (2001) Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol 76:89–92

    PubMed  Article  CAS  Google Scholar 

  30. Gotada T, Yanagisawa A, Sasako M et al (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225

    Article  Google Scholar 

  31. Bollschweiler E, Maruyama K, Siewert JR et al (1992) Preoperative assessment of lymph node metastases in patients with gastric cancer: evaluation of the Maruyama computer program. Br J Surg 79:156–160

    PubMed  Article  CAS  Google Scholar 

  32. Bollschweiler EH, Mönig SP, Hensler K et al (2004) Artificial neural network for prediction of lymph node metastases in gastric cancer: a phase II diagnostic study. Ann Surg Oncol 11:506–511

    PubMed  Article  Google Scholar 

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Acknowledgement

This study was supported by a grant-in-aid from the Ministry of Education, Culture, and Science of Japan.

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Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto, 860-8556, Japan

    Shinji Ishikawa, Nobutomo Miyanari, Masahiko Hirota, Hiroshi Takamori & Hideo Baba

  2. Yatsushiro Regional Hospital, 2-26 Matueshiromachi, Yatushiro City, Kumamoto, 866-8660, Japan

    Shinya Shimada

Authors
  1. Shinji Ishikawa
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  2. Shinya Shimada
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  3. Nobutomo Miyanari
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  4. Masahiko Hirota
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  5. Hiroshi Takamori
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  6. Hideo Baba
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Corresponding author

Correspondence to Hideo Baba.

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Ishikawa, S., Shimada, S., Miyanari, N. et al. Pattern of Lymph Node Involvement in Proximal Gastric Cancer. World J Surg 33, 1687 (2009). https://doi.org/10.1007/s00268-009-0083-6

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  • DOI: https://doi.org/10.1007/s00268-009-0083-6

Keywords

  • Gastric Cancer
  • Endoscopic Submucosal Dissection
  • Early Gastric Cancer
  • Total Gastrectomy
  • Muscularis Propria