Left Gastric Artery Lymph Nodes Should Be Included in D1 Lymph Node Dissection in Gastric Cancer
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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.
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.
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).
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.
KeywordsGastric cancer Lymph nodes Left gastric artery Station D1 lymph node dissection
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.
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.
Supported in part by the NIH/NCI under award number P30CA016672 and used the Clinical Trials Support Resource.
Compliance with Ethical Standards
Conflict of Interest
The authors have no conflicts of interest to disclose.
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