Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2712-2721
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2712
Prognostic significance of 14v-lymph node dissection to D2 dissection for lower-third gastric cancer
Chen Zheng, Zi-Ming Gao, An-Qi Sun, Hai-Bo Huang, Zhen-Ning Wang, Kai Li, Shan Gao
Chen Zheng, Zi-Ming Gao, An-Qi Sun, Hai-Bo Huang, Zhen-Ning Wang, Kai Li, Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Shan Gao, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Zheng C and Gao S designed research; Gao ZM, Sun AQ and Wang ZN treated patients and collected material and clinical data from patients; Zheng C and Huang HB performed the assays; Zheng C and Gao S analysed data; Zheng C and Li K wrote the paper.
Supported by Foundation for Innovative Talents in Higher Education of Liaoning Province, No. LR2016043.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of First Affiliated Hospital of China Medical University.
Informed consent statement: Written informed consent were obtained from each patient.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shan Gao, MD, Doctor, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. mount1121@hotmail.com
Telephone: +86-18940259333
Received: June 13, 2019
Peer-review started: June 18, 2019
First decision: July 30, 2019
Revised: August 6, 2019
Accepted: August 20, 2019
Article in press: August 20, 2019
Published online: September 26, 2019
Abstract
BACKGROUND

Radical gastrectomy with D2 lymph node (LN) dissection is the standard surgical procedure for patients with resectable gastric cancer (GC). In the fifteenth edition of the Japanese Classification of Gastric Carcinoma, the 14v LN (LNs along the root of the superior mesenteric vein) was defined as the regional gastric LN. The efficacy of 14v LN dissection during radical distal gastrectomy for lower-third GC remains controversial.

AIM

To analyze whether the addition of 14v LN dissection improved the survival of patients with lower-third GC.

METHODS

The data from 65 patients who underwent 14v LN dissection and 65 patients treated without 14v LN dissection were selected using the propensity score-matched method from our institute database constructed between 2000 and 2012. Overall survival was compared between the groups.

RESULTS

Overall survival was similar between patients with 14v LN metastasis and those with distant metastasis (P = 0.521). Among patients with pathological stage IIIA disease, those who were treated with 14v LN dissection had a significantly higher overall survival than those treated without it (P = 0.020). Multivariate analysis showed that age < 65 years and pT2-3 stage were independent favorable prognostic factors for prolonged overall survival in patients with pathological stage IIIA disease. Patients with No. 1, No. 6, No. 8a, or No. 11p LN metastasis were at higher risk of having 14v LN metastasis.

CONCLUSION

Adding 14v LN dissection to D2 dissection during radical distal gastrectomy may improve the overall survival of patients with pathological stage IIIA lower-third GC.

Keywords: Gastric cancer, No. 14v lymph node, Lymphadenectomy, Prognosis, Propensity score matching

Core Tip: The efficacy of 14v lymph node (LN) dissection during radical distal gastrectomy for lower-third gastric cancer (GC) remains controversial. The present propensity score-matched study indicated that among pathological stage lower-third GC IIIA patients, 14v LN dissection resulted in longer survival compared to treatment without it. The overall survival of patients with 14v LN metastasis was similar with that of patients with distant metastasis.