Reappraise role of No. 10 lymphadenectomy for proximal gastric cancer in the era of minimal invasive surgery during total gastrectomy: a pooled analysis of 4 prospective trial

Zhong, Qing; Chen, Qi‐Yue; Xu, Ying-Ying; Zhao, Gang; Cai, Lisheng; Li, Guoxin; Xu, Zekuan; Su, Yan; Wu, Zuguang; Xue, Fangqin; Sun, Yihong; Xu, Dongpo; Zhang, Wenbin; Wan, Jin; Yu, Peiwu; Hu, Jian‐Kun; Su, Xiangqian; Ji, Jiafu; Li, Ziyu; You, Jun; Li, Yong; Fan, Lin; Zheng, Chao‐Hui; Xie, Jian‐Wei; Li, Ping; Huang, Chang‐Ming

doi:10.1007/s10120-020-01110-3

Cited by 16 publications

(20 citation statements)

References 45 publications

(55 reference statements)

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“…Oh et al ( 26 ) showed that splenectomy patients had a poorer short-surgical outcome than spleen-preservation patients, and the survival analysis indicated that the 5-year OS of the spleen-preservation group was significantly higher than that of the splenectomy group in pN0 advanced GC patients. Zhong et al ( 27 ) study indicated that laparoscopic spleen-preserving No. 10 node dissection for GC was safe and feasible, and the 3-year OS of D2+ No.…”

Section: Splenic Hilar (No 10) Ln Dissection With or Without Splenectomy For Proximal Gcmentioning

confidence: 99%

Current status of lymph node dissection in gastric cancer

Ke¹,

Liang²

2021

Chinese Journal of Cancer Research

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Gastrectomy with lymph node (LN) dissection has been regarded as the standard surgery for gastric cancer (GC), however, the rational extent of lymphadenectomy remains controversial. Though gastrectomy with extended lymphadenectomy beyond D2 is classified as a non-standard gastrectomy, its clinical significance has been evaluated in many studies. Although hard evidence is lacking, D2 plus superior mesenteric vein (No. 14v) LN dissection is recommended when harbor metastasis to No. 6 nodes is suspected in the lower stomach, and dissection of splenic hilar (No. 10) LN can be performed for advanced GC invading the greater curvature of the upper stomach, and D2 plus posterior surface of the pancreatic head (No. 13) LN dissection may be an option in a potentially curative gastrectomy for cancer invading the duodenum. Prophylactic D2+ para-aortic nodal dissection (PAND) was not routinely recommended for advanced GC patients, but therapeutic D2 plus PAND may offer a chance of cure in selected patients, preoperative chemotherapy was considered as the standard treatment for GC with para-aortic node metastasis. There has been no consensus on the extent of lymphadenectomy for the adenocarcinoma of the esophagogastric junction (AEG) so far. The length of esophageal invasion can be used as a reference point for mediastinal LN metastases, and the distance from the esophagogastric junction to the distal end of the tumor is essential for determining the optimal extent of resection. The quality of lymphadenectomy may influence prognosis in GC patients. Both hospital volume and surgeon volume were important factors for the quality of radical gastrectomy. Centralization of GC surgery may be needed to improve prognosis.

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Section: Splenic Hilar (No 10) Ln Dissection With or Without Splenectomy For Proximal Gcmentioning

confidence: 99%

Current status of lymph node dissection in gastric cancer

Ke¹,

Liang²

2021

Chinese Journal of Cancer Research

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“…In this subgroup, the 3-year overall survival rate of the D2+ no. 10 group increased compared to the D2 group [ 77 ]. Consequently, the Japanese guideline mentions station 10 dissection as a low-evidence option for proximal carcinoma infiltrating the greater curvature [ 4 ].…”

Section: Standard Resection Proceduresmentioning

confidence: 99%

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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“…One study referred to the posterior No. 10 LND (22); and six studies did not reveal sufficient outcome information to perform analysis (23)(24)(25)(26)(27)(28). Finally, eight retrospective cohort studies involving 4,131 patients were included in the study (14,(29)(30)(31)(32)(33)(34)(35).…”

Section: Selection Of Trialsmentioning

confidence: 99%

Efficacy of the No. 10 lymphadenectomy with spleen preservation on patients with gastric cancer and/or esophagogastric junction adenocarcinoma who underwent total gastrectomy: a systematic review and meta-analysis

Xia¹,

Wang²,

Liu³

et al. 2022

Transl Cancer Res TCR

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Background Surgery with total gastrectomy and D2 lymph node dissection (LND) has been recommended as the standard treatment for patients with advanced upper and middle gastric carcinoma and/or Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG). However, whether the No. 10 lymph node (No. 10 LN, also known as splenic hilar LN) should be dissected in total gastrectomy remains controversial. We aimed to evaluate whether the No. 10 LND with spleen preservation has survival benefit for patients with gastric cancer and/or AEG who underwent the total gastrectomy. Methods The PubMed, Embase, the Cochrane Library, ClinicalTrials.gov and American Society of Clinical Oncology.org (ASCO.org) were electronically searched to identify eligible studies. The primary outcome was the survival rate, and secondary outcomes included the disease-free survival (DFS) rate and side effects. The Review Manager 5.3.5 software was used for the meta-analysis. The odds ratio (OR) and mean difference with 95% confidence interval (CI) were calculated. The statistical heterogeneity was assessed using chi-square (χ 2 ) and I 2 tests. Results Eight studies enrolling a total of 4,131 patients were eligible for our review. The meta-analysis results demonstrated that the No. 10 LND group was significantly better than the non-No. 10 LND group in terms of the 3- (OR =0.71, 95% CI: 0.62–0.81, P<0.00001) and the 5-year (OR =0.66, 95% CI: 0.58–0.75, P<0.00001) survival rates but not in the 1-year survival rate (OR =0.91, 95% CI: 0.75–1.11, P=0.36). The DFS rates in the No. 10 LND group were significantly increased after 1 (OR =0.76, 95% CI: 0.61–0.93, P=0.008), 3 (OR =0.69, 95% CI: 0.60–0.81, P<0.00001), and 5 (OR =0.66, 95% CI: 0.56–0.76, P<0.00001) years compared with those in the non-No. 10 LND group. Discussion Evidence shows that the No. 10 LND with spleen preservation can improve the survival and the DFS rates for patients with gastric cancer and/or Siewert type II/III AEG who underwent the total gastrectomy. High-quality prospective trials are expected.

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Reappraise role of No. 10 lymphadenectomy for proximal gastric cancer in the era of minimal invasive surgery during total gastrectomy: a pooled analysis of 4 prospective trial

Cited by 16 publications

References 45 publications

Current status of lymph node dissection in gastric cancer

Current status of lymph node dissection in gastric cancer

Surgery Matters: Progress in Surgical Management of Gastric Cancer

Efficacy of the No. 10 lymphadenectomy with spleen preservation on patients with gastric cancer and/or esophagogastric junction adenocarcinoma who underwent total gastrectomy: a systematic review and meta-analysis

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