Oncological risk of proximal gastrectomy for proximal advanced gastric cancer after neoadjuvant chemotherapy.
Neoadjuvant chemotherapy
Proximal gastrectomy
Proximal gastric cancer
Tumor regression grade
Journal
BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800
Informations de publication
Date de publication:
23 Feb 2024
23 Feb 2024
Historique:
received:
02
11
2023
accepted:
11
02
2024
medline:
24
2
2024
pubmed:
24
2
2024
entrez:
23
2
2024
Statut:
epublish
Résumé
This study assesses the metastasis rate of the key distal lymph nodes (KDLN) that are not routinely dissected in proximal gastrectomy, aiming to explore the oncological safety of proximal gastrectomy for upper gastric cancer who underwent neoadjuvant chemotherapy. We analyzed a cohort of 150 patients with proximal locally advanced gastric cancer (cT3/4 before chemotherapy) from two high-volume cancer centers in China who received preoperative neoadjuvant chemotherapy (NAC) and total gastrectomy with lymph node dissection. Metastasis rate of the KDLN (No.5/6/12a) and the risk factors were analyzed. Key distal lymph node metastasis was detected in 10% (15/150) of patients, with a metastasis rate of 6% (9/150) in No. 5 lymph nodes, 6.7% (10/150) in No. 6 lymph nodes, and 2.7% (2/75) in No. 12a lymph nodes. The therapeutic value index of KDLN as one entity is 5.8. Tumor length showed no correlation with KDLN metastasis, while tumor regression grade (TRG) emerged as an independent risk factor (OR: 1.47; p-value: 0.04). Of those with TRG3 (no response to NAC), 80% (12/15) was found with KDLN metastasis. For cT3/4 proximal locally advanced gastric cancer patients, the risk of KDLN metastasis remains notably high even after NAC. Therefore, proximal gastrectomy is not recommended; instead, total gastrectomy with thorough distal lymphadenectomy is the preferred surgical approach.
Identifiants
pubmed: 38395845
doi: 10.1186/s12885-024-11993-5
pii: 10.1186/s12885-024-11993-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
255Subventions
Organisme : National Natural Science Foundation of China
ID : 82203187
Organisme : Science and Technology Planning Project of Guangzhou
ID : 202201011111
Organisme : Program of Guangdong Provincial Clinical Research Center for Digestive Diseases
ID : 2020B1111170004
Organisme : Program of Guangdong Provincial Clinical Research Center for Digestive Diseases
ID : 2020B1111170004
Informations de copyright
© 2024. The Author(s).
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