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Therapeutic Value of Lymph Node Dissection in Advanced Gastric Cancer with Macroscopic Duodenum Invasion: Is the Posterior Pancreatic Head Lymph Node Dissection Beneficial?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In advanced gastric cancer (AGC) with duodenum invasion, the posterior pancreatic lymph nodes are susceptible to metastasis because of their proximity to the duodenum. The therapeutic value of lymph node dissection in this area for AGC with macroscopic duodenum invasion remains unclear.

Methods

Patients who had undergone curative gastrectomy for lower-third AGC from 1970 to 2004 at the Cancer Institute Hospital were recruited for this study. Clinicopathological data were collected retrospectively, and compared between cases of AGC with duodenum invasion (AGC-DI group) and AGC without duodenum invasion (AGC-nDI group). In the AGC-DI group, the therapeutic value of lymph node dissection was evaluated using a therapeutic index (multiplication of the frequency of metastasis to the station by the 5-year survival rate of patients with metastasis to that station).

Results

The AGC-DI group generally had tumors of higher pathological stage, which might account for the poorer 5-year survival rate compared with that of the AGC-nDI group (50.1% versus 68.5%; P = 0.0002). The incidence of lymph node metastasis was higher in the AGC-DI group than that in the AGC-nDI group, including nodes in the posterior pancreatic head (23.9% versus 7.0%, P < 0.0001). In the AGC-DI group, posterior pancreatic head lymph node dissection was of therapeutic value (4.19) equivalent to dissection of second-tier lymph nodes.

Conclusions

The dissection of posterior pancreatic head lymph nodes might be effective in AGC with macroscopic duodenum invasion since this has therapeutic value equivalent to that of second-tier lymph node dissection and might improve patients’ long-term outcomes.

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References

  1. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, 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.

    Article  PubMed  CAS  Google Scholar 

  2. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745–8.

    Article  PubMed  CAS  Google Scholar 

  3. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. 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.

    Article  PubMed  CAS  Google Scholar 

  4. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999;79:1522–30.

    Article  PubMed  CAS  Google Scholar 

  5. Kodera Y, Schwarz RE, Nakao A. Extended lymph node dissection in gastric carcinoma: where do we stand after the Dutch and British randomized trials? J Am Coll Surg. 2002;195:855–64.

    Article  PubMed  Google Scholar 

  6. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987;11:418–25.

    Article  PubMed  CAS  Google Scholar 

  7. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H. Can sentinel node biopsy indicate rational extent of lymphadenectomy in gastric cancer surgery? Fundamental and new information on lymph-node dissection. Langenbecks Arch Surg. 1999;384:149–57.

    Article  PubMed  CAS  Google Scholar 

  8. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002;5:1–5.

    Article  PubMed  Google Scholar 

  9. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer 1998;1:10–24.

    Article  PubMed  Google Scholar 

  10. Kakeji Y, Korenaga D, Baba H, Watanabe A, Tsujitani S, Maehara Y, et al. Surgical treatment of patients with gastric carcinoma and duodenal invasion. J Surg Oncol. 1995;59:215–9.

    Article  PubMed  CAS  Google Scholar 

  11. Kakeji Y, Tsujitani S, Baba H, Moriguchi S, Mori M, Maehara Y, et al. Clinicopathologic features and prognostic significance of duodenal invasion in patients with distal gastric carcinoma. Cancer. 1991;68:380–4.

    Article  PubMed  CAS  Google Scholar 

  12. 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.

    Article  PubMed  CAS  Google Scholar 

  13. Aiko T, Sasako M. The new Japanese classification of gastric carcinoma: points to be revised. Gastric Cancer. 1998;1:25–30.

    Article  PubMed  Google Scholar 

  14. Sasako M, Sano T, Katai H, et al. Radical surgery. In: Sugimura T, Sasako M, editors. Gastric cancer. Oxford: Oxford University Press; 1997. p. 223–48.

    Google Scholar 

  15. Castleman B. Extension of gastric carcinoma into the duodenum. Ann Surg. 1936;103:348–52.

    Article  PubMed  CAS  Google Scholar 

  16. Zinninger MM, Collins WT. Extension of carcinoma of the stomach into the duodenum and esophagus. Ann Surg. 1949;130:557–66.

    Article  Google Scholar 

  17. Paramanandhan TL. The duodenal spread of gastric carcinoma. Br J Surg. 1967;54:169–74.

    Article  PubMed  CAS  Google Scholar 

  18. Perng DS, Jan CM, Wang WM, Chen LT, Liu CS, Huang TJ, et al. Clinicopathologic study of gastric carcinoma with duodenal invasion. Kaohsiung J Med Sci. 1996;12:461–5.

    PubMed  CAS  Google Scholar 

  19. Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.

    Article  PubMed  CAS  Google Scholar 

  20. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, et al. Nodal dissection for patients with gastric cancer: a randomized controlled trial. Lancet Oncol. 2006;7:309–15.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Masanori Tokunaga MD, Shigekazu Ohyama MD, PhD, Naoki Hiki MD, PhD, Tetsu Fukunaga MD, PhD, Harutaka Inoue MD, PhD, Kazuhiko Yamada MD, PhD, Takeshi Sano MD, PhD, Toshiharu Yamaguchi MD, PhD & Toshifusa Nakajima MD, PhD

Authors
  1. Masanori Tokunaga MD
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  2. Shigekazu Ohyama MD, PhD
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  3. Naoki Hiki MD, PhD
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  4. Tetsu Fukunaga MD, PhD
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  5. Harutaka Inoue MD, PhD
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  6. Kazuhiko Yamada MD, PhD
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  7. Takeshi Sano MD, PhD
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  8. Toshiharu Yamaguchi MD, PhD
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  9. Toshifusa Nakajima MD, PhD
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Corresponding author

Correspondence to Shigekazu Ohyama MD, PhD.

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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 16, 1241–1246 (2009). https://doi.org/10.1245/s10434-009-0345-4

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  • DOI: https://doi.org/10.1245/s10434-009-0345-4

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