Oncotarget

Clinical Research Papers:

Impact of splenic hilar lymph node metastasis on prognosis in patients with advanced gastric cancer

Taeil Son, In Gyu Kwon, Joong Ho Lee, Youn Young Choi, Hyoung-Il Kim, Jae-Ho Cheong, Sung Hoon Noh and Woo Jin Hyung _

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Oncotarget. 2017; 8:84515-84528. https://doi.org/10.18632/oncotarget.18762

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Abstract

Taeil Son1,2, In Gyu Kwon3, Joong Ho Lee4, Youn Young Choi1,2, Hyoung-Il Kim1,2, Jae-Ho Cheong1,2, Sung Hoon Noh1,2 and Woo Jin Hyung1,2

1Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea

2Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea

3Department of Surgery, Keimyung University School of Medicine, Daegu, South Korea

4Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, South Korea

Correspondence to:

Woo Jin Hyung, email: [email protected]

Keywords: gastric cancer, D2 lymphadenectomy, splenic hilar lymph node, prognosis

Received: February 15, 2017     Accepted: June 10, 2017     Published: June 28, 2017

ABSTRACT

Background: Impact of splenic hilar LN dissection during total gastrectomy for proximal advanced gastric cancer is controversial. The objective of this study was to assess the impact on prognosis of splenic hilar lymph node(LN) metastasis compared to that of metastasis to other regional LN groups.

Study Design: Patients who underwent total gastrectomy with D2 LN dissection from 2000 to 2010 were reviewed retrospectively. The clinicopathologic characteristics and long-term results of patients with splenic hilar LN metastasis were compared to those of patients with only metastasis to other extraperigastric LNs (stations #8a, #9, #11, or #12a). To investigate the survival benefit of performing splenic hilar LN dissection, the estimated therapeutic index for the procedure was calculated by multiplying the incidence of metastases in the hilar region by the survival rates for individuals with nodal involvement in that region.

Results: Of 602 patients, 87(14.5%) had hilar LN metastasis. The 5-year overall and relapse-free survival rates for patients with hilar LN metastasis were 24.1% and 12.1%, respectively. These rates were similar to those for patients with metastasis to other extraperigastric LNs (P > 0.05), with similar recurrence patterns. Overall survival in the hilar LN metastasis group was better than that for patients with distant metastasis(P < 0.05). The estimated therapeutic index of splenic hilar LN dissection was 3.5, which was similar to index values for LN dissection at other extraperigastric LNs.

Conclusions: Dissection of splenic hilar LNs during total gastrectomy for advanced gastric cancer allows for a prognosis similar to that achieved with dissection of extraperigastric LNs.


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