Optimal extent of lymph node dissection for remnant advanced gastric carcinoma after distal gastrectomy: a retrospective

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ORIGINAL ARTICLE

Optimal extent of lymph node dissection for remnant advanced gastric carcinoma after distal gastrectomy: a retrospective analysis of more than 3000 patients from the nationwide registry of the Japanese Gastric Cancer Association Hitoshi Katai1   · Takashi Ishikawa2 · Kohei Akazawa2 · Takeo Fukagawa3 · Yoh Isobe4 · Isao Miyashiro5 · Ichiro Oda6 · Shunichi Tsujitani7 · Hiroyuki Ono8 · Satoshi Tanabe9 · Souya Nunobe10 · Satoshi Suzuki11 · Yoshihiro Kakeji11 · the Registration Committee of the Japanese Gastric Cancer Association Received: 28 February 2020 / Accepted: 3 May 2020 © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2020

Abstract Background  No guidelines are available for defining the extent of lymph node (LN) dissection in patients with remnant gastric carcinoma (RGC). Hence, this retrospective study aimed to determine the optimal extent of LN dissection in patients with RGC. Methods  We retrospectively evaluated the therapeutic outcomes of node dissection for RGC from a nationwide registry. When the metastatic rate or 5-year survival rate exceeded 10%, dissection was recommended. We calculated the dissection index by multiplying the incidence of metastasis at that nodal station by the 5-year survival rate of patients with metastasis at the station. A dissection index of > 1.0 was considered significant. Results  We included 1133 patients with RGC (T2–T4 tumor) who had undergone distal gastrectomy as the primary surgery for the evaluation of the survival benefit of nodal dissection. Any regional node station was considered significant. When the primary surgery was for malignant disease, the index was high for Nos. 3 (10.2), 7 (9.5), 1 (7.1), and 9 (8.0) nodes. For nodes at the splenic hilum, the index value was 4.4, which was higher than that for the perigastric nodes (Nos. 4sa and 4sb). The index for No. 10 nodes was the highest (10.5) when tumors involved a greater curvature. Conclusions  The therapeutic strategy for RGC remains the same, regardless of the histology of the primary disease during the initial surgery. Total gastrectomy and dissection of the perigastric LNs (Nos. 1–4), suprapancreatic LNs (Nos. 7–9 and 11), and LNs at the splenic hilum (No. 10) are justified. Keywords  Upper GI · Remnant gastric carcinoma · Lymph node dissection

* Hitoshi Katai [email protected] 1

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Department of Gastroenterological Surgery, Tottori University, Tottori, Japan

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Endoscopy Division, Shizuoka Cancer Center, Shizuoka, Japan

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Department of Advanced Medicine Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan



Department of Gastric Surgery, National Cancer Center Hospital, 5‑1‑1 Tsukiji, chuo‑ku, Tokyo 104‑0045, Japan

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Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan

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Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan

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Department of Surgery, National Hospital Organization Tokyo Medical C