Indication of Proximal Gastrectomy for Advanced Proximal Gastric Cancer Based on Lymph Node Metastasis at the Distal Part of the Stomach.
Journal
Annals of surgery open : perspectives of surgical history, education, and clinical approaches
ISSN: 2691-3593
Titre abrégé: Ann Surg Open
Pays: United States
ID NLM: 101769928
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
16
07
2021
accepted:
07
10
2021
medline:
24
11
2021
pubmed:
24
11
2021
entrez:
28
8
2023
Statut:
epublish
Résumé
To suggest the possible indication of proximal gastrectomy for advanced gastric cancer located at the upper third of the stomach. Proximal gastrectomy has been an alternative surgical procedure for early proximal gastric cancer due to its benefits for quality of life while maintaining oncological outcomes. However, the oncological safety of proximal gastrectomy for advanced tumors remains unclear. We retrospectively reviewed data from 878 patients who underwent radical total gastrectomy from 2003 to 2018 for pathologic T2-T4 gastric cancer in the upper third of the stomach. We identified risk factors for lymph node metastasis at the distal part of the stomach, which was not dissected in proximal gastrectomy. Subsequently, we evaluated the metastasis rate and therapeutic value index of lymph nodes at the distal part of the stomach in patients with none of these risk factors. Multivariable analysis revealed that esophagogastric junction (EGJ)-tumor epicenter distance >30 mm, tumor size >70 mm, macroscopic type IV tumor, and serosal invasion were risk factors for lymph node metastasis at the distal stomach. In patients without risk factors, the therapeutic value index for any lymph nodes at the distal stomach was 0.8, suggesting that lymph node dissection could be omitted in these patients. EGJ-tumor epicenter distance ≤ 30 mm, tumor size ≤ 70 mm, not a macroscopic type IV tumor, and no serosal invasion could be an indication of proximal gastrectomy for advanced gastric cancer located at the upper third of the stomach.
Sections du résumé
Objective
UNASSIGNED
To suggest the possible indication of proximal gastrectomy for advanced gastric cancer located at the upper third of the stomach.
Background
UNASSIGNED
Proximal gastrectomy has been an alternative surgical procedure for early proximal gastric cancer due to its benefits for quality of life while maintaining oncological outcomes. However, the oncological safety of proximal gastrectomy for advanced tumors remains unclear.
Methods
UNASSIGNED
We retrospectively reviewed data from 878 patients who underwent radical total gastrectomy from 2003 to 2018 for pathologic T2-T4 gastric cancer in the upper third of the stomach. We identified risk factors for lymph node metastasis at the distal part of the stomach, which was not dissected in proximal gastrectomy. Subsequently, we evaluated the metastasis rate and therapeutic value index of lymph nodes at the distal part of the stomach in patients with none of these risk factors.
Results
UNASSIGNED
Multivariable analysis revealed that esophagogastric junction (EGJ)-tumor epicenter distance >30 mm, tumor size >70 mm, macroscopic type IV tumor, and serosal invasion were risk factors for lymph node metastasis at the distal stomach. In patients without risk factors, the therapeutic value index for any lymph nodes at the distal stomach was 0.8, suggesting that lymph node dissection could be omitted in these patients.
Conclusions
UNASSIGNED
EGJ-tumor epicenter distance ≤ 30 mm, tumor size ≤ 70 mm, not a macroscopic type IV tumor, and no serosal invasion could be an indication of proximal gastrectomy for advanced gastric cancer located at the upper third of the stomach.
Identifiants
pubmed: 37637877
doi: 10.1097/AS9.0000000000000107
pmc: PMC10455053
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e107Informations de copyright
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
This work was supported by the National Research Foundation of Korea grant funded by the Korea government (MSIP; No. 2016R1A2B4014984). The funding source had no role in the design or conduct of the study; data collection, analysis, or interpretation; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Disclosure: The authors declare that they have nothing to disclose.
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