Elsevier

Surgical Oncology

Volume 48, June 2023, 101908
Surgical Oncology

The definition of “R1” lymph node dissection status in patients undergoing curative-aim gastrectomy for gastric carcinoma: A proof of concept study

https://doi.org/10.1016/j.suronc.2023.101908Get rights and content
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Highlights

  • R1-Lymph node dissection is an independent predictor of disease-specific survival.

  • R1-Lymph node dissection is a stronger prognostic factor for loco-regional recurrence than R1 on the stomach margin.

  • R1-Lymph node dissection is a prognostic factor that could guide the indication for postoperative chemoradiotherapy (CRT).

  • During a gastrectomy, Extending the lymph node dissection one ‘level’ further than the one involved could aid in removing micrometastatic disease.

Abstract

Introduction

The aim of this study was to define and investigate the prognostic impact of “R1-Lymph-node dissection” during gastrectomy.

Methods

This was a retrospective study conducted with 499 patients undergoing curative-aim gastrectomy. We defined R1-Lymph dissection as an involvement of lymph node stations anatomically connected with lymph node stations outside the declared level of dissection (D1 to D2+). The primary outcomes were disease-free and disease-specific survival (DFS and DSS).

Results

At multivariable analysis, the type of gastrectomy, pT and pN were associated with DFS, and the type of gastrectomy, R1-Margin status, R1-Lymph status, pT, pN and adjuvant therapy were associated with DSS. Moreover, pT and R1-Lymph status were the only factors associated with overall loco-regional recurrence.

Conclusions

In this study, we introduced the concept of R1-Lymph-node dissection, which was significantly associated with DSS and appeared to be a stronger prognostic factor for loco-regional recurrence than the R1 status on the resection margin.

Keywords

Gastric cancer
Lymph node dissection
R0 resection
Radical gastrectomy
Loco-regional recurrence

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