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17-08-2017 | Gastric cancer | Article

Left Gastric Artery Lymph Nodes Should Be Included in D1 Lymph Node Dissection in Gastric Cancer

Journal:
Journal of Gastrointestinal Surgery

Authors: Naruhiko Ikoma, Mariela Blum, Jeannelyn S. Estrella, Xuemei Wang, Keith F. Fournier, Paul F. Mansfield, Jaffer A. Ajani, Brian D. Badgwell

Publisher: Springer US

Abstract

The Japanese Classification of Gastric Carcinoma includes the left gastric artery (#7) lymph nodes (LNs) in the recommended extent of D1 LN dissection, but this recommendation has not been validated in western institutions.
We reviewed data from a prospectively maintained database of gastric cancer patients who underwent resection at our academic cancer center and had a separate pathologic assessment of #7 LN in 2005–2016. Risk factors for #7 LN metastases and overall survival were examined by uni- and multivariable analyses.
We identified 173 patients; 114 (66%) were treated with preoperative therapy, most commonly with chemoradiation therapy (47%, 81/173). We identified 22 patients (13%) who had #7 LN metastases, which accounted for 35% (22/63) of node-positive patients. No preoperative factors were associated with #7 LN metastases by univariable analyses. Patients with #7 metastases were not associated with shorter overall survival after adjustment by nodal stage (hazard ratio 1.49, 95% confidence interval 0.67–3.32; p = 0.33).
Metastasis to #7 LN station was common in gastric cancer, but the survival impact was not significant after adjustment by nodal stage. We conclude that #7 LNs should be routinely dissected in gastric cancer patients, and this station should be included within the extent of D1 LN dissection.

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