Current status of lymph node dissection in gastric cancer

Ke, Bin; Liang, Han

doi:10.21147/j.issn.1000-9604.2021.02.07

Cited by 18 publications

(13 citation statements)

References 53 publications

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“…D2 radical resection has been accepted as the only effective treatment for resectable GC [ 9 10 11 ]. However, a large proportion of patients experience recurrence and metastasis within 2 years of D2 radical resection, resulting in poor prognosis, with a 5-year survival rate of <50% [ 12 13 14 15 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Different Number of XELOX or SOX Chemotherapy Cycles After D2 Resection for Stage III Gastric Cancer

Zhang

Meng

et al. 2022

J Gastric Cancer

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Purpose We aimed to explore whether the prognosis of patients treated with capecitabine and oxaliplatin (XELOX) or S-1 and oxaliplatin (SOX) regimens who received fewer cycles of chemotherapy after D2 radical resection for gastric cancer (GC) would be non-inferior to that of patients who received the standard number of cycles of chemotherapy. Materials and Methods Data on patients who received XELOX or SOX chemotherapy after undergoing D2 radical resection at Harbin Medical University Cancer Hospital between January 2011 and May 2016 were collected. Results In patients who received 4, 6, and 8 cycles of chemotherapy, the 5-year overall survival (OS) rates were 59.4%, 64.8%, and 62.7%, respectively. Compared to patients who received 4 cycles of chemotherapy, those who received 6 cycles (hazard ratio [HR], 0.882; 95% confidence interval [CI], 0.599–1.299; P=0.52) or 8 cycles (HR, 0.882; 95% CI, 0.533–1.458; P=0.62) of chemotherapy did not exhibit significantly prolonged OS. The 3-year disease-free survival (DFS) rate of patients who received 4, 6, and 8 cycles of chemotherapy was 62.1%, 67.2%, and 60.8%, respectively. Compared to patients who received 4 cycles of chemotherapy, those who received 6 cycles (HR, 0.835; 95% CI, 0.572–1.221; P=0.35) or 8 cycles (HR, 0.972; 95% CI, 0.606–1.558; P=0.91) of chemotherapy did not show significantly prolonged DFS. However, the 3-year DFS and 5-year OS rates of patients who received 6 cycles of chemotherapy appeared to be superior to those of patients who received 4 and 8 cycles of chemotherapy. Conclusions For patients with stage III GC, 4 to 6 cycles of XELOX or SOX chemotherapy may be a favorable option. This study provides a rationale for further randomized clinical trials.

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Section: Introductionmentioning

confidence: 99%

Efficacy of Different Number of XELOX or SOX Chemotherapy Cycles After D2 Resection for Stage III Gastric Cancer

Zhang

Meng

et al. 2022

J Gastric Cancer

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“…As the most important independent prognostic factor for GC, [1–3] great emphasis was put on the LN involvement assessing, and currently, two N-stage systems were most recognized: the Japanese Classification of Gastric Carcinoma (JCGC, 13th edition) N-classification system and Union International Cancer Control (UICC-TNM, 8th edition) N-staging system. JCGC N-classification system is based on the anatomic location-based involved node stations, whereas the UICC-TNM N-staging system is based on the number of MLNs [2,22,23] .…”

Section: Discussionmentioning

confidence: 99%

“…As we knew, postoperative adjuvant chemotherapy based on histological and biological characteristics to determine tailored treatment for specific subgroups could further improve the prognosis of GC patients. [38] Although LN metastasis has been demonstrated to be the strongest predictor of disease recurrence for GC [1][2][3] and even might be the active hubs for systemic tumor cell spread. [8,9] At the same time, it has been demonstrated that more intensive adjuvant chemotherapy was safe and could significantly improve prognosis for the subgroup GC patients with an indication for intense adjuvant chemotherapy in serious trials in Japan, including the Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer study, [39] the Japan Clinical Oncology Group 1104 trial, [40] and the Japan Clinical Cancer Research Organization GC-07 trial.…”

Section: Discussionmentioning

confidence: 99%

“…GC remains one of the leading causes of cancer-related deaths worldwide [4,5] . Unfortunately, LN dissection in GC has reached a plateau in improving the prognosis since D2 lymphadenectomy been accepted as the standard surgical procedure [1,6,7] . Even more, new research progress has shown that LN is an effective gateway from lymphatics into the systemic circulation, and becoming a source of cancer cells for distant metastasis [8,9] .…”

Section: Introductionmentioning

confidence: 99%

“…As the most common metastasis mode and most important independent prognostic factor of gastric cancer (GC), [1–3] lymph node (LN) involvement contributes a lot to the status. GC remains one of the leading causes of cancer-related deaths worldwide [4,5] .…”

Section: Introductionmentioning

confidence: 99%

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Diabetes mellitus promoted lymph node metastasis in gastric cancer: a 15–year single-institution experience

Chen

et al. 2021

Chinese Medical Journal

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Background:Previous studies have revealed that diabetes mellitus (DM) promotes disease progress of gastric cancer (GC). This study aimed to further investigating whether DM advanced lymph nodes (LNs) metastasis in GC.Methods:The clinicopathologic data of GC patients with >15 examined LN (ELN) between October 2004 and December 2019 from a prospectively maintained database were included. The observational outcomes included the number (N3b status) and anatomical distribution (N3 stations) of metastatic LN (MLN).Results:A total of 2142 eligible patients were included in the study between October 2004 and December 2019. N3 stations metastasis (26.8% in DM vs. 19.3% in non-DM, P = 0.026) and N3b status (18.8% in DM vs. 12.8% in non-DM, P = 0.039) were more advanced in the DM group, and multivariate logistic regression analyses confirmed that DM was an independent factor of developing N3 stations metastasis (odds ratio [OR] = 1.771, P = 0.011) and N3b status (OR = 1.752, P = 0.028). Also, multivariate analyses determined DM was independently associated with more MLN (β = 1.424, P = 0.047). The preponderance of N3 stations metastasis (DM vs. non-DM, T1–2: 2.2% vs. 4.9%, T3: 29.0% vs. 20.3%, T4a: 38.9% vs. 25.8%, T4b: 50.0% vs. 36.6%; ELN16–29: 8.6% vs. 10.4%, ELN30–44: 27.9% vs. 20.5%, ELN ≥ 45: 37.7% vs. 25.3%), N3b status (DM vs. non-DM, T1–2: 0% vs. 1.7%, T3: 16.1% vs. 5.1%, T4a: 27.8% vs. 19.1%, T4b: 44.0% vs. 28.0%; ELN16–29: 8.6% vs. 7.9%, ELN30–44: 18.0% vs. 11.8%, ELN ≥ 45: 26.4% vs. 17.3%), and the number of MLN (DM vs. non-DM, T1–2: 0.4 vs. 1.1, T3: 8.6 vs. 5.2, T4a: 9.7 vs. 8.6, T4b: 17.0 vs. 12.8; ELN16–29: 3.6 vs. 4.6, ELN30–44: 5.8 vs. 5.5, ELN ≥ 45: 12.0 vs. 7.7) of DM group increased with the advancement of primary tumor depth stage and raising of ELN.Conclusions:DM was an independent risk factor for promoting LN metastasis. The preponderance of LN involvement in the DM group was aggravated with the advancement of tumor depth.

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Surgery Matters: Progress in Surgical Management of Gastric Cancer

Beyer

2023

Curr. Treat. Options in Oncol.

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Opinion statementThe surgical treatment of gastric carcinoma has progressed significantly in the past few decades. A major milestone was the establishment of multimodal therapies for locally advanced tumours. Improvements in the technique of endoscopic resection have supplanted surgery in the early stages of many cases of gastric cancer. In cases in which an endoscopic resection is not possible, surgical limited resection procedures for the early stages of carcinoma are an equal alternative to gastrectomy in the field of oncology. Proximal gastrectomy is extensively discussed in this context. Whether proximal gastrectomy leads to a better quality of life and better nutritional well-being than total gastrectomy depends on the reconstruction chosen. The outcome cannot be conclusively assessed at present. For locally advanced stages, total or subtotal gastrectomy with D2 lymphadenectomy is now the global standard. A subtotal gastrectomy requires sufficiently long tumour-free proximal resection margins. Recent data indicate that proximal margins of at least 3 cm for tumours with an expansive growth pattern and at least 5 cm for those with an infiltrative growth pattern are sufficient. The most frequently performed reconstruction worldwide following gastrectomy is the Roux-en-Y reconstruction. However, there is evidence that pouch reconstruction is superior in terms of quality of life and nutritional well-being. Oncological gastric surgery is increasingly being performed laparoscopically. The safety and oncological equivalency were first demonstrated for early carcinomas and then for locally advanced tumours, by cohort studies and RCTs. Some studies suggest that laparoscopic procedures may be advantageous in early postoperative recovery. Robotic gastrectomy is also increasing in use. Preliminary results suggest that robotic gastrectomy may have added value in lymphadenectomy and in the early postoperative course. However, further studies are needed to substantiate these results. There is an ongoing debate about the best treatment option for gastric cancer with oligometastatic disease. Preliminary results indicate that certain patient groups could benefit from resection of the primary tumour and metastases following chemotherapy. However, the exact conditions in which patients may benefit have yet to be confirmed by ongoing trials.

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Current status of lymph node dissection in gastric cancer

Cited by 18 publications

References 53 publications

Efficacy of Different Number of XELOX or SOX Chemotherapy Cycles After D2 Resection for Stage III Gastric Cancer

Efficacy of Different Number of XELOX or SOX Chemotherapy Cycles After D2 Resection for Stage III Gastric Cancer

Diabetes mellitus promoted lymph node metastasis in gastric cancer: a 15–year single-institution experience

Surgery Matters: Progress in Surgical Management of Gastric Cancer

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