Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1390
Peer-review started: April 7, 2021
First decision: June 14, 2021
Revised: July 6, 2021
Accepted: October 24, 2021
Article in press: October 24, 2021
Published online: November 27, 2021
Controversy over the issue that station 12a lymph node involvement is distant or regional metastasis remains, and whether station 12a lymph nodes should be included in D2 lymphadenectomy or not is unclear.
To investigate the risk factors for station 12a lymph node metastasis and evaluate the survival outcomes of station 12a lymph node dissection in patients with lower-third gastric cancer (GC).
To investigate whether the clinicopathological factors and metastasis status of other perigastric lymph nodes can predict station 12a lymph node metastasis and evaluate the prognostic significance of station 12a lymph node dissection in patients with lower-third GC.
Survival prognoses were compared between patients with or without station 12a lymph node metastasis. Logistic regression analyses were used to clarify the association between station 12a lymph node metastasis and clinicopathological factors or metastasis status of other perigastric lymph nodes.
The incidence of station 12a lymph node involvement was reported as 12.2% in patients with lower-third GC. The overall survival of patients without station 12a lymph node metastasis was significantly better than that of patients with station 12a lymph node metastasis (P < 0.001), which could also be seen in patients with or without extranodal soft tissue invasion. Advanced pN stage was defined as an independent risk factor significantly correlated with station 12a lymph node positivity. Station 3 lymph node status was also proven to be significantly correlated with station 12a lymph node involvement.
The dissection of station 12a lymph nodes may not be ignored in D2 or D2+ lymphadenectomy due to difficulties in predicting station 12a lymph node metastasis.
Controversy over the issue that station 12a lymph node involvement is distant or regional metastasis remains, and the possible inclusion of station 12a lymph nodes in the D2 lymphadenectomy is unclear. As reported, GC located in the lower third was highly related to the metastasis of station 12a lymph nodes. The clinicopathological factors related to station 12a lymph node metastasis in patients with lower-third GC were investigated in this study. The results showed that station 3 lymph node status was highly related to station 12a lymph node metastasis. The poor prognosis of patients with station 12a lymph node metastasis compared with those without indicated that station 12a lymph node dissection must be considered. This study further validated the significance of the study of station 12a lymph node metastasis in patients with lower third GC.