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Annals of Surgical Oncology

, Volume 20, Issue 8, pp 2669–2675 | Cite as

Is There Any Role of Additional Retropancreatic Lymph Node Dissection on D2 Gastrectomy for Advanced Gastric Cancer?

  • Bang Wool Eom
  • Jungnam Joo
  • Young-Woo KimEmail author
  • Boram Park
  • Ji Yeon Park
  • Hong Man Yoon
  • Jun Ho Lee
  • Keun Won Ryu
Gastrointestinal Oncology

Abstract

Background

Extended lymph node dissection beyond D2 in resectable gastric cancer has not shown any survival benefits. However, whether the retropancreatic (No. 13) lymph node should be dissected still remains controversial. The purpose of this study was to evaluate the effects of additional No. 13 lymph node dissection on D2 gastrectomy for gastric cancer in terms of overall survival.

Methods

From May 2001 to December 2006, 528 patients underwent curative resection for the middle- or lower-third advanced gastric cancer at the National Cancer Center, Korea. The patients were grouped according to whether a No. 13 lymphadenectomy was performed (13D+/13D−). Clinicopathological characteristics and treatment-related factors were compared between the two groups. The overall survival was analyzed using the Cox proportional hazard model.

Results

The incidence of No. 13 lymph node metastasis was 6.7 %. There was no significant difference in morbidity or mortality between the 13D+ and 13D− groups. In clinical stages I/II, No. 13 lymph node dissection did not affect overall survival. However, it was an independent prognostic factor in patients with clinical stages III/IV gastric cancer (hazard ratio (HR), 0.55; P = 0.022).

Conclusions

Additional retropancreatic lymph node dissection beyond a D2 gastrectomy might be favorable for survival in patients with clinical stage III/IV middle- or lower-third gastric cancer.

Keywords

Gastric Cancer Clinical Stage Advanced Gastric Cancer Propensity Score Match Lymph Node Ratio 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This work was supported by grant of National Cancer Center (No. NCC-0310060-1,2,3). The study was approved by the institutional review board of the Korean National Cancer Center (No. NCCNCS-11-513).

References

  1. 1.
    Huang CM, Lin JX, Zheng CH, Li P, Xie JW, Lin BJ. Effect of negative lymph node count on survival for gastric cancer after curative distal gastrectomy. Eur J Surg Oncol. 2011;37:481–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Xu DZ, Geng QR, Long ZJ, et al. Positive lymph node ratio is an independent prognostic factor in gastric cancer after d2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol. 2009;16:319–26.PubMedCrossRefGoogle Scholar
  3. 3.
    Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007;245:543–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Adachi Y, Shiraishi N, Suematsu T, Shiromizu A, Yamaguchi K, Kitano S. Most important lymph node information in gastric cancer: multivariate prognostic study. Ann Surg Oncol. 2000;7:503–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Siewert JR, Bottcher K, Roder JD, Busch R, Hermanek P, Meyer HJ. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German gastric carcinoma study group. Br J Surg. 1993;80:1015–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Marubini E, Bozzetti F, Miceli R, Bonfanti G, Gennari L, Gastrointestinal Tumor Study Group. Lymphadenectomy in gastric cancer: prognostic role and therapeutic implications. Eur J Surg Oncol. 2002;28:406–12.PubMedCrossRefGoogle Scholar
  7. 7.
    Bösing NM, Goretzki PE, Röher HD. Gastric cancer: which patients benefit from systematic lymphadenectomy? Eur J Surg Oncol. 2000;26:498–505.PubMedCrossRefGoogle Scholar
  8. 8.
    Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.PubMedCrossRefGoogle Scholar
  10. 10.
    Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22:2069–77.PubMedCrossRefGoogle Scholar
  11. 11.
    Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer. 1999;79:1522–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Dent DM, Madden MV, Price SK. Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma. Br J Surg. 1988;75:110–2.PubMedCrossRefGoogle Scholar
  14. 14.
    Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011;253:900–11.PubMedCrossRefGoogle Scholar
  15. 15.
    McCulloch P, Nita ME, Kazi H, Gama-Rodrigues J. Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2004;4:CD001964.Google Scholar
  16. 16.
    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. Lancet Oncol. 2010;11:439–49.PubMedCrossRefGoogle Scholar
  17. 17.
    Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy-Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–73.PubMedCrossRefGoogle Scholar
  18. 18.
    Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.PubMedCrossRefGoogle Scholar
  19. 19.
    Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol. 2006;7:309–15.PubMedCrossRefGoogle Scholar
  20. 20.
    Japanese gastric cancer association. Japanses gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer. 2011;14:113–23.CrossRefGoogle Scholar
  21. 21.
    Tokunaga M, Ohyama S, Hiki N, et al. Therapeutic value of lymph node dissection in advanced gastric cancer with macroscopic duodenum invasion: is the posterior pancreatic head lymph node dissection beneficial? Ann Surg Oncol. 2009;16:1241–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer. 1998;1:10–24.PubMedCrossRefGoogle Scholar
  23. 23.
    Sobin LH. TNM classification of malignant tumours. 6th ed. New York: Wiley-Liss; 2002.Google Scholar
  24. 24.
    Sobin LH. TNM classification of malignant tumours. 7th ed. New York: Wiley; 2009.Google Scholar
  25. 25.
    Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995;82:346–51.PubMedCrossRefGoogle Scholar
  26. 26.
    Maruyama K, Gunvén P, Okabayashi K, Sasako M, Kinoshita T. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg. 1989;210:596–602.Google Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Bang Wool Eom
    • 1
  • Jungnam Joo
    • 2
  • Young-Woo Kim
    • 1
    Email author
  • Boram Park
    • 2
  • Ji Yeon Park
    • 1
  • Hong Man Yoon
    • 1
  • Jun Ho Lee
    • 1
  • Keun Won Ryu
    • 1
  1. 1.Gastric Cancer BranchResearch Institute and Hospital, National Cancer CenterGoyang-siSouth Korea
  2. 2.Biometric Research BranchResearch Institute for National Cancer Control and Evaluation, National Cancer CenterGoyang-siSouth Korea

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