Lymph node dissection around the splenic artery and hilum in advanced middle third gastric carcinoma

doi:10.1016/j.ejso.2008.03.011

European Journal of Surgical Oncology (EJSO)

Volume 35, Issue 7, July 2009, Pages 709-714

https://doi.org/10.1016/j.ejso.2008.03.011 Get rights and content

Abstract

Aim

To evaluate the clinicopathological factors influencing lymph node metastasis around the splenic artery and hilum and the effect of spleen-preserved lymphadenectomy in advanced middle third gastric carcinoma.

Methods

We retrospectively studied 131 patients with advanced middle third gastric carcinoma who had received D2 lymphadenectomy and lymph node dissection around the splenic artery and hilum, from 2000 to 2004. Of these patients, 62 simultaneously underwent splenectomy and 69 underwent spleen-preserved lymphadenectomy.

Results

The incidences of Nos. 10 and 11 lymph node metastases were 21% and 15%, respectively, in advanced middle third gastric carcinoma. A tumor size larger than 5 cm, metastases of Nos. 1 and 7–9 lymph node were independent risk factors for metastasis of No. 10 and/or No. 11 lymph node. The spleen-preserved group had a slightly better survival rate and a relatively lower rate of postoperative complications than the splenectomy group. No. 10 and/or No. 11 lymph node metastasis was an independent prognostic factor, while splenectomy was not.

Conclusions

It is necessary to remove the lymph nodes around the splenic artery and hilum to achieve radical resection in advanced middle third gastric carcinoma patients with risk factors. Our results demonstrate that spleen-preserved lymphadenectomy is a good option for those patients.

Introduction

Unlike tumors of the upper and lower third regions of the stomach, middle third gastric carcinoma is often not diagnosed until the tumor becomes bulky and metastasizes to the regional lymph nodes because there are no obvious symptoms at earlier stages.¹ When the tumors advance, the lymph nodes around the splenic artery and hilum are also frequently involved.² Several studies have reported that the incidence of lymph node metastasis is 9.7–20% along the splenic artery and 9.2–17% at the splenic hilum in advanced proximal and middle third gastric carcinoma.3, 4, 5, 6, 7

Gastrectomy with lymphadenectomy is still the best method to cure patients with gastric carcinoma. The extent of gastrectomy for advanced middle third gastric carcinoma depends on the location of the tumor, and total gastrectomy is usually performed to obtain negative margins.⁸ D2 lymphadenectomy is generally accepted as the standard surgery for gastric carcinoma in Japan and Korea. According to the Japanese Classification of Gastric Carcinoma,⁹ the lymph nodes along the distal splenic artery (No. 11d) and at the splenic hilum (No. 10) are group 3 lymph nodes for middle third gastric carcinoma. Due to the high frequency of lymph node metastasis around the splenic artery and hilum, splenectomy or spleen-preserved lymphadenectomy around the splenic artery and hilum is an important surgical consideration for patients with advanced middle third gastric cancer.6, 10, 11 However, the effect of the extended lymph node dissection and splenectomy for advanced middle third gastric carcinoma is unknown.

The purpose of this study is to evaluate both the clinicopathological factors influencing lymph node metastasis around the splenic artery and hilum and the effect of spleen-preserved lymphadenectomy in cases of advanced middle third gastric carcinoma.

Section snippets

Tumor location

According to the Japanese Classification of Gastric Carcinoma, the location of a tumor is classified as the upper, middle, or lower (U, M or L) third of the stomach longitudinally. In this study, middle third carcinoma of the stomach was defined by the tumor being located in the middle third region of the stomach (M or ML). The tumors located in LM, UM or MU were excluded from this study.

Patients

From January 2000 to December 2004, 3267 patients with gastric carcinoma underwent gastrectomy in the

Status of lymph node metastasis

The mean total number of retrieved lymph nodes was 54, and a mean number of 5.2 lymph nodes were found around the splenic artery and hilum of each specimen. The incidence of No. 10 and/or No. 11 lymph node metastasis was 31% in advanced middle third gastric carcinoma. No. 10 alone, No. 11 alone, and both Nos. 10 and 11 lymph node metastases were observed in 20, 12, and 8 patients, respectively.

Univariate analysis

In a comparison between patients with and without No. 10 and/or No. 11 lymph node metastasis, the

Metastasis of lymph node Nos. 10 and 11

Lymph node metastasis in gastric carcinoma is associated with tumor advancement. In early gastric carcinoma of the middle third of the stomach, dissection of lymph node around the splenic artery and hilum does not need to be performed because metastasis of the lymph node is not found in these areas. However, in advanced middle third gastric carcinoma, dissection of the lymph nodes around the splenic artery and hilum should be surgically considered, because 10–20% of patients undergoing extended

Conflict of interest

The authors have no conflict of interest.

Acknowledgement

This study was supported in part by a grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (0412-CR01-0704-0001).

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Lymph node dissection around the splenic artery and hilum in advanced middle third gastric carcinoma

Abstract

Aim

Methods

Results

Conclusions

Introduction

Section snippets

Tumor location

Patients

Status of lymph node metastasis

Univariate analysis

Metastasis of lymph node Nos. 10 and 11

Conflict of interest

Acknowledgement

Am J Surg

Eur J Surg Oncol

Surgery

Am J Surg

J Surg Res

Selection of operative procedure for adenocarcinoma of the midstomach. Twenty years' experience with implications for future treatment strategy

Ann Surg

Adenocarcinoma of midstomach. Clinical and pathoanatomic relation to lymph node metastases

J Clin Gastroenterol

Lymph node metastasis at the splenic hilum in proximal gastric cancer

Am Surg

Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus

J Surg Oncol

Radical resection of gastric carcinoma with pancreas and spleen preservation and functional cleaning of lymph nodes

Chin Med J

Pancreas-preserving total gastrectomy for proximal gastric cancer

World J Surg