Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study
| Autor: | Kazumasa Fujitani, Shuji Takiguchi, Yutaka Kimura, Kazuhiro Nishikawa, Shigeyuki Tamura, Shoki Mikata, Hiroshi Imamura, Masaki Mori, Jyunya Fujita, Johji Hara, Isao Miyashiro, Yuichiro Doki, Yukinori Kurokawa |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty medicine.medical_treatment Adenocarcinoma Surgical oncology Gastrectomy Stomach Neoplasms medicine Humans Survival rate Aged Retrospective Studies Aged 80 and over business.industry Gastroenterology Cardia General Medicine Middle Aged medicine.disease Prognosis digestive system diseases Surgery Survival Rate Oncology Multicenter study Lymphatic Metastasis Multivariate Analysis Lymph Node Excision Lymphadenectomy Female Radiology NODAL business Abdominal surgery |
| Zdroj: | Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 16(3) |
| ISSN: | 1436-3305 |
| Popis: | It remains uncertain whether radical lymphadenectomy combined with total gastrectomy actually contributes to long-term survival for Siewert type II adenocarcinoma of the cardia. We identified the pattern of abdominal nodal spread in advanced type II adenocarcinoma and defined the optimal extent of abdominal lymphadenectomy.Eighty-six patients undergoing R0 total gastrectomy for advanced type II adenocarcinoma were identified from the gastric cancer database of 4,884 patients. Prognostic factors were investigated by multivariate analysis. The therapeutic value of lymph node dissection for each station was estimated by multiplying the incidence of metastasis by the 5-year survival rate of patients with positive nodes in each station.The overall 5-year survival rate was 37.1%. Age less than 65 years [hazard ratio, 0.455 (95% confidence interval (CI), 0.261-0.793)] and nodal involvement with pN3 as referent [hazard ratio for pN0, 0.129 (95% CI, 0.048-0.344); for pN1, 0.209 (95% CI, 0.097-0.448); and for pN2, 0.376 (95% CI, 0.189-0.746)] were identified as significant prognosticators for longer survival. Perigastric nodes of the lower half of the stomach in positions 4d-6 were considered not beneficial to dissect, whereas there were substantial therapeutic benefits to dissecting the perigastric nodes of the upper half of the stomach in positions 1-3 and the second-tier nodes in positions 7 and 11.Limited lymphadenectomy attained by proximal gastrectomy might suffice as an alternative to extended lymphadenectomy with total gastrectomy for obtaining potential therapeutic benefit in abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma. |
| Databáze: | OpenAIRE |
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