Assessment of LN Metastasis in Patients with Gastric Cancer
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Segmental gastrectomy, a type of function-preserving surgery, is not broadly studied but can improve postoperative function and quality of life among patients with gastric cancer (GC). The findings suggest that middle segmental gastrectomy with dissection of LN stations 1, 3, 4sb, 4d, 7, 8a, 9, 11p, and 12a can be recommended for high-body and middle-body cT1N0/1M0 gastric cancers 4 cm or smaller and well-differentiated cT2N0/1M0 cancers.

The study objective was to establish an indication for middle segmental gastrectomy (MSG) as a treatment for middle-body (MB) and high-body (HB) GC.

This cohort study analyzed patients with GC undergoing surgery. Inclusion criteria were age 18 to 85 years, histologically proven adenocarcinoma located in the HB or MB, cT1 to cT3 category cancers, curative resection with negative margins performed, and follow-up for at least 3 years. Exclusion criteria were Borrmann type 4 GC, T4 category cancer, neoadjuvant chemotherapy, and a history of other cancers.

Among 9952 patients who underwent surgery for GC, 8219 underwent either laparoscopic or open total or subtotal gastrectomy. 773 patients had GC in the MB or HB of the stomach. Among the 701 patients included in the final analysis after exclusion of the cN2/N3 carcinomas, the mean (SD) age was 56.35 years, and 418 were men.

--The incidence of LN metastasis was 0% at station 5 for cT1-3N0/1M0 cancers, station 4sa for cT1-2N0/1M0 cancers, station 2 for cT1N0/1M0 cancers, station 6 for cT1N1M0 cancers, station 11d for cT1N1M0-cT2N0/1M0 cancers, and station 12a for cT1N0/1M0-T2N1M0 cancers, regardless of size and differentiation.

--The rates of LN metastasis for cT1N0M0 cancers were 0.3% at station 6 and 0.8% at station 11d.

--Tumors 4 cm or smaller were associated with a lower risk of LN metastasis compared with tumors 4.1 cm or larger, and well-differentiated tumors were associated with a lower risk of LN metastasis compared with poorly differentiated tumors.

These findings suggest that MSG with dissection of stations 1, 3, 4sb, 4d, 7, 8a, 9, 11p, and 12a could be done for HB and MB cT1N0/1M0 gastric cancers 4 cm or smaller and well-differentiated cT2N0/1M0 cancers.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777603?widget=personalizedcontent&previousarticle=0
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