Comparison of Standard D2 and Limited Lymph Node Dissection in Elderly Patients with Advanced Gastric Cancer

Ko, Chang Seok; Jheong, Jin Ho; Jeong, Seong-A; Kim, Byung Sik; Yook, Jeong Hwan; Yoo, Myung Hoon; Kim, Beom Su; Kim, Sehee; Gong, Chung Sik

doi:10.1245/s10434-022-11480-w

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…At present, radical gastrectomy combined with D2 lymphadenectomy is still the most effective treatment for GC (2,3). The status of lymph nodes (LNs) is a stronger prognostic factor for the survival of GC patients and sufficient lymphadenectomy can improve the prognosis of GC patients (4)(5)(6). Howerer, lymphadenectomy for GC is usually performed without the aid of visual instruments and complete lymphadenectomy is sometimes difficult, especially for inexperienced gastrointestinal surgeons, which always results in LNs residue and in turn leads to tumor recurrence as well as the death of these patient.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Dong

Zhang

et al. 2022

Front. Oncol.

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BackgroundIndocyanine green (ICG) imaging-guided lymphadenectomy has been introduced in gastric cancer (GC) surgery and its clinical value remains controversial. The aim of this study is to evaluate the efficacy of ICG fluorescence imaging-guided lymphadenectomy in radical gastrectomy for GC.MethodsStudies comparing lymphadenectomy in radical gastrectomy between use and non-use of ICG fluorescence imaging up to July 2022 were systematically searched from PubMed, Web of Science, Embase and Cochrane Library. A pooled analysis was performed for the available data regarding the baseline features, the number of retrieved lymph nodes (LNs), the number of metastatic LNs and surgical outcomes as well as oncological outcomes. RevMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted.Results17 studies with a total of 2274 patients (1186 in the ICG group and 1088 in the control group) undergoing radical gastrectomy and lymphadenectomy were included. In the pooled analysis, the baseline features were basically comparable. However, the number of retrieved LNs in the ICG group was significantly more than that in the control group (MD = 7.41, 95% CI = 5.44 to 9.37, P < 0.00001). No significant difference was found between the ICG and control groups in terms of metastatic LNs (MD = -0.05, 95% CI = -0.25 to 0.16, P = 0.65). In addition, the use of ICG could reduce intraoperative blood loss (MD = -17.96, 95% CI = -27.89 to -8.04, P = 0.0004) without increasing operative time (P = 0.14) and overall complications (P = 0.10). In terms of oncological outcomes, the use of ICG could reduce the overall recurrence rate (OR = 0.50; 95% CI 0.28-0.89; P = 0.02) but could not increase the 2-year overall survival rate (OR = 1.25; 95% CI 0.72-2.18; P = 0.43).ConclusionsICG imaging-guided lymphadenectomy is valuable for complete LNs dissection in radical gastrectomy for GC. However, more high-quality randomized controlled trials are needed to confirm this benefit.

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Section: Introductionmentioning

confidence: 99%

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Dong

Zhang

et al. 2022

Front. Oncol.

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“…Regarding the extent of lymphadenectomy, various studies have shown the efficacy of D2 gastrectomy to be controversial compared to D1 gastrectomy in elderly gastric cancer patients 29 – 32 . However, two recent studies report that standard D2 surgery contributes to a better prognosis compared to limited surgery, even in elderly gastric cancer patients 33 , 34 . In real-world data from nationwide general hospitals, patients had more high-risk comorbidities than those in high-volume centers.…”

Section: Discussionmentioning

confidence: 99%

Differences of clinical features and outcomes between male and female elderly patients in gastric cancer

Arakawa,

Komatsu,

Kamiya

et al. 2023

Sci Rep

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Although the average life span differs between males and females, little is known about differences in clinical features and short and long-term outcomes between elderly male and female gastric cancer patients. This study was designed to clarify these issues to identify the possibility for sex-based treatment strategies in elderly gastric cancer patients. This study included 295 consecutive elderly gastric cancer patients (75 years or older) who underwent curative gastrectomy between 1997 and 2016. We defined postoperative complications as Clavien–Dindo classification grade II or higher. Comorbidities were present in 67% of all patients. Males tended to have more comorbidities than females (P = 0.077). Male patients had significantly more upper gastric cancers (P = 0.001), a higher incidence of postoperative complications (P = 0.045), and poorer prognoses than females (P = 0.003). Multivariate analysis revealed that being male was an independent risk factor for postoperative complications (Odds ratio 2.5, P = 0.045) and a poor prognostic factor (Hazard ratio 1.81, P = 0.008). Patients who underwent limited surgery without postoperative complications tended to have a better prognosis than patients receiving standard surgery with postoperative complications (3-year overall survival: 78% vs. 55%, P = 0.156). Male was an independent risk factor for postoperative complications and an independent poor prognostic factor in elderly gastric cancer patients. To avoid postoperative complications, the limited surgery might be justified for high-risk elderly male patients.

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“…Ko et al showed that standard lymphadenectomy correlated with relatively good prognosis in elderly patients with advanced gastric cancer. 10 In that study, most of the patients had an ASA PS of one to two, which suggested few comorbidities and relatively low surgical risk. On the other hand, some studies demonstrated no significant difference in the long-term prognosis between limited D1 LND and D2 LND, 4,5 which is consistent with our findings.…”

Section: Discussionmentioning

confidence: 80%

“…Ko et al showed that standard lymphadenectomy correlated with relatively good prognosis in elderly patients with advanced gastric cancer 10 . In that study, most of the patients had an ASA PS of one to two, which suggested few comorbidities and relatively low surgical risk.…”

Section: Discussionmentioning

confidence: 81%

Optimal extent of lymph node dissection for high‐risk gastric cancer stratified by a national clinical database risk calculator

Kuroda,

Miki,

Kasashima

et al. 2024

World j. surg.

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BackgroundFor patients with gastric cancer, a well‐balanced treatment that considers both oncological aspects and surgical risk is demanded. This study aimed to explore the optimal extent of lymph node dissection (LND) for patients with gastric cancer according to surgical risk, stratified by the risk calculator system produced by the Japan National Clinical Database (NCD).Patients and MethodsWe retrospectively evaluated 187 patients who underwent radical gastrectomy for gastric cancer. Using the median predicted anastomotic leak rate obtained by the NCD risk calculator as the cutoff value, we classified 97 and 90 patients as having high and low risks, respectively.ResultsIn low‐risk patients, although limited LND reduced the postoperative intraabdominal infectious complications (IAIC), multivariate analysis revealed standard LND as an independent prognostic factor that improved Relapse‐free survival (RFS). In high‐risk patients, the rates of postoperative IAIC and RFS were similar between standard and limited LND. Pancreatic fistula was not observed in the limited dissection group.ConclusionLimited LND might be the optimal treatment strategy for patients with gastric cancer with high surgical risk.

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Comparison of Standard D2 and Limited Lymph Node Dissection in Elderly Patients with Advanced Gastric Cancer

Cited by 6 publications

References 20 publications

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Differences of clinical features and outcomes between male and female elderly patients in gastric cancer

Optimal extent of lymph node dissection for high‐risk gastric cancer stratified by a national clinical database risk calculator

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