Skip to main content
SpringerLink
Log in
Book cover

Lymph Node Metastasis in Gastrointestinal Cancer pp 267–282Cite as

Gastric Cancer

  • Chapter
  • First Online:

Abstract

Lymph node metastasis is the most important prognostic factor in potentially curable gastric cancer. Since 2010 the TNM classifications and the Japanese classification have been harmonized in terms of the N-category determined with the number of metastatic lymph nodes and of the stage grouping.

The D-number to describe the extent of lymph node dissection in gastrectomy is used to be defined in accordance with lymph node groups based on the primary tumor location. In the third edition of the Japanese guidelines published in 2010, the lymph node stations to be dissected in D1, D1+, and D2 were newly defined for total or distal gastrectomy regardless of the tumor location.

The 15-year follow-up of the Dutch trial demonstrated that the locoregional recurrence rate was significantly lower in patients treated with D2 than D1, showing a survival benefit. Today the D2 procedure has been recommended in most guidelines for patients with resectable advanced gastric cancer. There are debates on an optimal extent of lymph node dissection in esophagogastric junction cancer or cancer with duodenal invasion.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Hermanek P, Sobin LH. International union against cancer: TNM classification of malignant tumours. 4th fully revised ed. Berlin: Springer-Verlag; 1987.

    Google Scholar 

  2. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 2nd English edition. Gastric Cancer. 1998;1:10–24.

    Article  CAS  Google Scholar 

  3. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.

    Article  Google Scholar 

  4. Ichikura T, Tomimatsu S, Okusa Y, Uefuji K, Tamakuma S. Comparison of the prognostic significance between the number of metastatic lymph nodes and nodal stage based on their location in patients with gastric cancer. J Clin Oncol. 1993;11(10):1894–900.

    Article  CAS  Google Scholar 

  5. Wu CW, Hsieh MC, Lo SS, et al. Relation of number of positive lymph nodes to the prognosis of patients with primary gastric adenocarcinoma. Gut. 1996;38(4):525–7.

    Article  CAS  Google Scholar 

  6. Sobin LH, Fleming ID. TNM Classification of Malignant tumors, fifth edition (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer. 1997;80(9):1803–4.

    Article  CAS  Google Scholar 

  7. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th ed. Oxford: Blackwell Publishing Ltd; 2010.

    Google Scholar 

  8. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 2010;17:3077–9.

    Article  Google Scholar 

  9. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22(14):2767–73.

    Article  Google Scholar 

  10. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359(5):453–62.

    Article  CAS  Google Scholar 

  11. Wittekind CH, Compton CC, Brierley J, Sobin LH. The TNM clinical and pathological classifications. In: TNM supplement. A commentary on uniform use. Oxford: Wiley-Blackwell; 2012. p. 7.

    Google Scholar 

  12. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345(8952):745–8.

    Article  CAS  Google Scholar 

  13. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347(9007):995–9.

    Article  CAS  Google Scholar 

  14. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol. 2006;7(4):309–15.

    Article  CAS  Google Scholar 

  15. Kajitani T. The general rules for the gastric cancer study in surgery and pathology. Part I. Clinical classification. Jpn J Surg. 1981;11(2):127–39.

    Article  CAS  Google Scholar 

  16. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995;82(3):346–51.

    Article  CAS  Google Scholar 

  17. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23.

    Article  Google Scholar 

  18. Sue-Ling HM, Johnston D, Martin IG, et al. Gastric cancer: a curable disease in Britain. Br Med J. 1993;307:591–6.

    Article  CAS  Google Scholar 

  19. Degiuli M, Sasako M, Ponti A, et al. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg. 2010;97(5):643–9.

    Article  CAS  Google Scholar 

  20. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49.

    Article  Google Scholar 

  21. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v38–49.

    Article  CAS  Google Scholar 

  22. Griffith JP, Sue-Ling HM, Martin I, Dixon MF, McMahon MJ, Axon AT, et al. Preservation of the spleen improves survival after radical surgery for gastric cancer. Gut. 1995;36(5):684–90.

    Article  CAS  Google Scholar 

  23. Wanebo HJ, Kennedy BJ, Winchester DP, Stewart AK, Fremgen AM. Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on long term survival. J Am Coll Surg. 1997;185(2):177–84.

    Article  CAS  Google Scholar 

  24. Csendes A, Burdiles P, Rojas J, Braghetto I, Diaz JC, Maluenda F. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery. 2002;131(4):401–7.

    Article  Google Scholar 

  25. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg. 2006;93(5):559–63.

    Article  CAS  Google Scholar 

  26. Toge T, Kameda A, Kuroi K, Seto Y, Yamada H, Hattori T. The role of the spleen in immunosuppression and the effects of splenectomy on prognosis in gastric cancer patients. Nihon Geka Gakkai Zasshi. 1985;86(9):1120–3.

    CAS  PubMed  Google Scholar 

  27. Yang K, Chen XZ, Hu JK, et al. Effectiveness and safety of splenectomy for gastric carcinoma: a meta-analysis. World J Gastroenterol. 2009;15:5352–9.

    Article  Google Scholar 

  28. Sano T, Sasako M, Mizusawa J, Yamamoto S, Katai H, Yoshikawa T, et al. Randomized controlled trial to evaluate splenectomy in Total gastrectomy for proximal gastric carcinoma. Ann Surg. 2017;265(2):277–83.

    Article  Google Scholar 

  29. Kitamura M, Arai K, Iwasaki Y. Clinicopathological studies and problems on para-aortic lymph node dissection: D4 dissection. Nippon Geka Gakkai Zasshi. 1996;97:302–7.

    CAS  PubMed  Google Scholar 

  30. Isozaki H, Okajima K, Fujii K, et al. Effectiveness of paraaortic lymph node dissection for advanced gastric cancer. Hepato-Gastroenterology. 1999;46:549–54.

    CAS  PubMed  Google Scholar 

  31. Sasako M, Sano T, Yamamoto S, Sairenji M, Arai K, Kinoshita T, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol. 2006;7(8):644–51.

    Article  Google Scholar 

  32. Yoshikawa T, Sasako M, Yamamoto S, et al. Phase II study of neoadjuvant chemotherapy and extended surgery for locally advanced gastric cancer. Br J Surg. 2009;96(9):1015–22.

    Article  CAS  Google Scholar 

  33. Tsuburaya A, Mizusawa J, Tanaka Y, et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg. 2014;101(6):653–60.

    Article  CAS  Google Scholar 

  34. Ito S, Sano T, Mizusawa J, et al. A phase II study of preoperative chemotherapy with docetaxel, cisplatin, and S-1 followed by gastrectomy with D2 plus para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis: JCOG1002. Gastric Cancer. 2017;20(2):322–31.

    Article  CAS  Google Scholar 

  35. Nishi M, Kaji S, Akune T, et al. Cardia cancer: a proposal of esophagogastric junction cancer. Geka Shinryo. 1973;15:1328–38. (in Japanese)

    Google Scholar 

  36. Siewert JR, Stein HJ. Carcinoma of the cardia: carcinoma of the gastroesophageal junction—classification, pathology and extent of resection. Dis Esophagus. 1996;9:173–82.

    Article  Google Scholar 

  37. Fujitani K, Miyashiro I, Mikata S, Tamura S, Imamura H, Hara J, et al. Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study. Gastric Cancer. 2013;16(3):301–8.

    Article  Google Scholar 

  38. Mine S, Sano T, Hiki N, Yamada K, Nunobe S, Yamaguchi T. Lymphadenectomy around the left renal vein in Siewert type II adenocarcinoma of the oesophagogastric junction. Br J Surg. 2013;100(2):261–6.

    Article  CAS  Google Scholar 

  39. Yamashita H, Seto Y, Sano T, et al. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer. 2017;20(Supple 1):S69–83.

    Article  Google Scholar 

  40. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.

    Article  Google Scholar 

  41. Tokunaga M, Ohyama S, Hiki N, Fukunaga T, Inoue H, Yamada K, et al. Therapeutic value of lymph node dissection in advanced gastric cancer with macroscopic duodenum invasion: is the posterior pancreatic head lymph node dissection beneficial? Ann Surg Oncol. 2009;16(5):1241–6.

    Article  Google Scholar 

  42. Kakeji Y, Korenaga D, Baba H, Watanabe A, Tsujitani S, Maehara Y, et al. Surgical treatment of patients with gastric carcinoma and duodenal invasion. J Surg Oncol. 1995;59(4):215–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Koshi Kumagai & Takeshi Sano

Authors
  1. Koshi Kumagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeshi Sano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koshi Kumagai .

Editor information

Editors and Affiliations

  1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima, Japan

    Shoji Natsugoe

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kumagai, K., Sano, T. (2019). Gastric Cancer. In: Natsugoe, S. (eds) Lymph Node Metastasis in Gastrointestinal Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-4699-5_14

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-4699-5_14

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4698-8

  • Online ISBN: 978-981-10-4699-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation