Lymph Node Metastasis among Adults with Gastric Adenocarcino
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This recent study suggests that proximal gastrectomy can be performed for category cT1-T2N0/1M0 tumors less than 4.1 cm with any histologic differentiation and for T3 category differentiated tumors less than 4.1 cm.

It is unclear whether proximal gastrectomy (PG) can replace total gastrectomy (TG), even in cases of advanced gastric carcinoma. This JAMA study was aimed to evaluate the oncologic safety of PG based on the lymph node (LN) metastasis rate and develop a selection diagram for PG eligibility.

Among 9952 patients who underwent surgery for gastric carcinoma, 2347 underwent TG. 655 had gastric carcinoma in the upper third of the stomach. The inclusion criteria were age 18 to 85 years, histologically proven adenocarcinoma located in the upper third of the stomach, curative R0 TG performed, and postoperative follow-up for at least 3 years.

The study findings were;
--Only those with poorly differentiated cT3 category carcinomas had an increased incidence of LN metastasis at stations 4d and 11d, independent of tumor size.

--For cT1-T3N0/1M0 category carcinomas, the incidence of station 5 LN metastasis was 0, irrespective of tumor size and differentiation.

--The LN metastasis rate at stations 4d and 6 for cT1-T3N0/1M0 differentiated tumors was also 0.

--Tumor size greater than or equal to 4.1 cm was associated with significantly increased LN metastasis compared with tumors less than 4.1 cm.

In particular, PG can be safely performed for cT1-T2N0/1M0 tumors less than 4.1 cm in diameter that is located in the upper third of the stomach. The cT3N0/1M0-differentiated tumors less than 4.1 cm may also be eligible for PG, whereas poorly differentiated cT3 tumors and any cT4 or cN2/3 diseases require TG.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776098
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