Risk factors of lymph node metastasis in the splenic hilum of gastric cancer patients: a meta-analysis
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(2020) 18:233
RESEARCH
Open Access
Risk factors of lymph node metastasis in the splenic hilum of gastric cancer patients: a meta-analysis Jun Du†, Yangchao Shen, Wenwu Yan and Jinguo Wang*†
Abstract Background: The issue of whether or not splenic hilum lymph nodes (SHLN) should be excised in radical gastrectomy with D2 lymph node dissection remains controversial. In this study, we identified the clinicopathological features in patients with gastric cancer that could serve as predictive risk factors of SHLN metastasis. Methods: We searched Medline, Embase, PubMed, and Web of Science databases from inception to May 2020 and consulted the related references. Overall, 15 articles evaluating a total of 4377 patients were included for study. The odds ratios (OR) of each risk factor and corresponding 95% confidence intervals (CI) were determined using the Revman 5.3 software. Results: Our meta-analysis revealed tumor size greater than 5 cm (p < 0.01), tumor localization in the greater curvature (p < 0.01), diffuse type (Lauren’s classification) (p < 0.01), Borrmann types 3–4 (p < 0.01), poor differentiation and undifferentiation (p < 0.01), depth of invasion T3–T4 (p < 0.01), number of lymph node metastases N2–N3 (p < 0.01), distant metastasis M1 (p < 0.01), TNM stages 3–4 (p < 0.01), vascular invasion (p = 0.01), and lymphatic invasion (p < 0.01) as potential risk factors of SHLN metastasis. Moreover, positivity of Nos. 1, 2, 3, 4sa, 4sb, 4d, 6, 7, 9, 11, and 16 lymph nodes for metastasis was strongly associated with SHLN metastasis. Conclusions: Tumor size, tumor location, Lauren’s diffuse type, Borrmann type, degree of differentiation, T stage, N stage, M stage, TNM stage, vascular invasion, lymphatic infiltration, and other positive lymph nodes are risk factors for SHLN metastasis. Keywords: Gastric cancer, Splenic hilum lymph node, Risk factors, Meta-analysis
Introduction Despite a downward trend in mortality rates, gastric cancer (GC) remains the third leading cause of cancerrelated death and the fifth most commonly diagnosed cancer type worldwide [1]. Surgical resection is currently the only effective means to treat GC. According to the Japanese gastric cancer treatment guidelines, standard * Correspondence: [email protected] † Jun Du and Jinguo Wang contributed equally to this work. Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
gastrectomy involves resection of at least two-thirds of the stomach with D2 lymph node dissection. The No. 10 lymph node is also within the scope of resection in proximal GC [2]. The deep anatomical position of the splenic hilum leads to narrowing of the operative space. Owing to the fragility of the spleen and variability of splenic hilum vessels, SHLNs dissection is difficult to perform [3]. Although splenic hilum lymph nodes can be completely removed with splenectomy, its application remains a subject of debate. An earlier large-scale randomized controlled trial showed no significant
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