Role of D2 gastrectomy in gastric cancer with clinical para-aortic lymph node metastasis

Autor: Lin Yang, Xiao-Hao Zheng, Ning Li, Yibin Xie, Chun-Xia Du, Yantao Tian, Wen Zhang, Gu-Sheng Xing
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Metastasis
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Gastrectomy
Stomach Neoplasms
Retrospective Study
Antineoplastic Combined Chemotherapy Protocols
Medicine
Humans
Aorta
Aged
Neoplasm Staging
Retrospective Studies
Chemotherapy
Multidisciplinary
business.industry
Therapeutic effect
Gastroenterology
Cancer
Conversion
General Medicine
Middle Aged
medicine.disease
Primary tumor
Neoadjuvant Therapy
Progression-Free Survival
Surgery
Radiation therapy
Survival Rate
Para-aortic lymph node
030220 oncology & carcinogenesis
Lymphatic Metastasis
Lymph Node Excision
030211 gastroenterology & hepatology
Female
Radiotherapy
Adjuvant
Lymph Nodes
Neoadjuvant
Palm
business
Gastric cancer
Follow-Up Studies
Zdroj: World Journal of Gastroenterology
ISSN: 2219-2840
Popis: Background Owing to the technical difficulty of pathological diagnosis, imaging is still the most commonly used method for clinical diagnosis of para-aortic lymph node metastasis (PALM) and evaluation of therapeutic effects in gastric cancer, which leads to inevitable false-positive findings in imaging. Patients with clinical PALM may have entirely different pathological stages (stage IV or not), which require completely different treatment strategies. There is no consensus on whether surgical intervention should be implemented for this group of patients. In particular, the value of D2 gastrectomy in a multidisciplinary treatment (MDT) approach for advanced gastric cancer with clinical PALM remains unknown. Aim To investigate the value of D2 gastrectomy in a MDT approach for gastric cancer patients with clinical PALM. Methods In this real-world study, clinico-pathological data of all gastric cancer patients treated at the Cancer Hospital, Chinese Academy of Medical Sciences between 2011 and 2016 were reviewed to identify those with clinically enlarged PALM. All the clinico-pathological data were prospectively documented in the patient medical record. For all the gastric cancer patients with advanced stage disease, especially those with suspicious distant metastasis, the treatment methods were determined by a multidisciplinary team. Results In total, 48 of 7077 primary gastric cancer patients were diagnosed as having clinical PALM without other distant metastases. All 48 patients received chemotherapy as the initial treatment. Complete or partial response was observed in 39.6% (19/48) of patients in overall and 52.1% (25/48) of patients in the primary tumor. Complete response of PALM was observed in 50.0% (24/48) of patients. After chemotherapy, 45.8% (22/48) of patients received D2 gastrectomy, and 12.5% (6/48) of patients received additional radiotherapy. The postoperative major complication rate and mortality were 27.3% (6/22) and 4.5% (1/22), respectively. The median overall survival and progression-free survival of all the patients were 18.9 and 12.1 mo, respectively. The median overall survival of patients who underwent surgical resection or not was 50.7 and 12.8 mo, respectively. The 3-year and 5-year survival rates were 56.8% and 47.3%, respectively, for patients who underwent D2 resection. Limited PALM and complete response of PALM after chemotherapy were identified as favorable factors for D2 gastrectomy. Conclusion For gastric cancer patients with radiologically suspicious PALM that responds well to chemotherapy, D2 gastrectomy could be a safe and effective treatment and should be adopted in a MDT approach for gastric cancer with clinical PALM.
Databáze: OpenAIRE
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