Extent of lymph node dissection for adenocarcinoma of the stomach

Mocellin, Simone; McCulloch, Peter; Kazi, Hussain; Gama-Rodrigues, J. J.; Yuan, Yuhong; Nitti, Donato

doi:10.1002/14651858.cd001964.pub4

Cited by 81 publications

(60 citation statements)

References 48 publications

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“…This finding is supported by a recent meta-analysis suggesting no significant difference in OS between these two types of lymph node dissection (22). This, however, must be cautiously interpreted because our median follow-up was 46.5 months and some authors argue that the survival benefit is apparent only after a longer follow-up.…”

Section: Discussionsupporting

confidence: 84%

Predictors of overall survival after surgery in gastric cancer patients from a Latin-American country

Cordero-García¹,

Ramos-Esquivel²,

Alpízar‐Alpízar³

2018

J. Gastrointest. Oncol.

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Section: Discussionsupporting

confidence: 84%

Predictors of overall survival after surgery in gastric cancer patients from a Latin-American country

Cordero-García¹,

Ramos-Esquivel²,

Alpízar‐Alpízar³

2018

J. Gastrointest. Oncol.

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“…As one of the most important determinants of recurrence and long-term survival in patients undergoing radical gastrectomy is nodal metastases, management of nodal disease is a key component to ensuring the best patient outcome (5). Specifically, the proper extent of lymph node dissection and the specific number of nodes required for adequate staging has generated decades of discourse with variable worldwide practice (6, 7). …”

Section: Introductionmentioning

confidence: 99%

Lymphadenectomy with Optimum of 29 Lymph Nodes Retrieved Associated with Improved Survival in Advanced Gastric Cancer: A 25,000-Patient International Database Study

Woo

Goldner

Ituarte

et al. 2017

Journal of the American College of Surgeons

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Background Gastric adenocarcinoma is an aggressive disease with frequent lymph node (LN) metastases for which lymphadenectomy results in a survival benefit. In the United States, the NCCN guidelines recommend D2 lymphadenectomy or a minimum of 15 LNs retrieved. However, retrieval of only 15 LNs is considered by most international guidelines as inadequate. We seek to evaluate the survival benefits associated with a more complete lymphadenectomy. Study Design An international database was constructed by combining gastric cancer cases from the SEER database (n=13,932) and the Yonsei University Gastric Cancer database (n=11,358)(total n=25,289). Kaplan-Meier survival analysis was performed along with Joinpoint analysis to obtain the optimal number of LNs to retrieve based upon survival. Prognostic significance of number of nodes retrieved was then confirmed with uni- and multivariate analyses. Results Analysis for both mean and median survival yielded 29 LNs removed as the Joinpoint. This was further confirmed with multivariate analysis, where 15 retrieved LNs cutoff fell out of the model while 29 retrieved LNs remained intact with an hazard ratio (HR): 0.799(95%CI 0.759–0.842, p<0.001). Stage-stratified Kaplan- Meier analysis for a cutoff point of 29 also demonstrated a statistically significant improvement in survival. Conclusion Joinpoint analysis has allowed for the creation of a model demonstrating the point at which additional dissection would not provide further benefit. Thus, this large international dataset analysis demonstrates that the maximal survival advantage is seen by performing a lymphadenectomy with a minimum of 29 LNs retrieved.

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“…[10][11][12]22,23 Recent evidence supports a modified D2 resection, sparing the spleen and pancreatic lymph nodes in the elderly and might expand its suitability in this group of patients. 24 In our study, a significantly higher number of D2 resections were performed in the elderly group of patients. There was no significant difference in the rate of complications and mortality between the two groups in our study.…”

Section: Discussionmentioning

confidence: 56%

Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre

Tandon

Rajendran

Aziz

et al. 2017

annals

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BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.

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Extent of lymph node dissection for adenocarcinoma of the stomach

Cited by 81 publications

References 48 publications

Predictors of overall survival after surgery in gastric cancer patients from a Latin-American country

Predictors of overall survival after surgery in gastric cancer patients from a Latin-American country

Lymphadenectomy with Optimum of 29 Lymph Nodes Retrieved Associated with Improved Survival in Advanced Gastric Cancer: A 25,000-Patient International Database Study

Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre

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