Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2022; 14(12): 2393-2403
Published online Dec 15, 2022. doi: 10.4251/wjgo.v14.i12.2393
Clinical value of regional lymph node sorting in gastric cancer
Chuan Li, Xiao-Jie Tian, Geng-Tao Qu, Yu-Xin Teng, Zhu-Feng Li, Xin-Yang Nie, Dong-Jie Liu, Tong Liu, Wei-Dong Li
Chuan Li, Xiao-Jie Tian, Geng-Tao Qu, Yu-Xin Teng, Zhu-Feng Li, Xin-Yang Nie, Dong-Jie Liu, Tong Liu, Wei-Dong Li, Department of General Surgery, Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin 300000, China
Author contributions: Li C and Tian XJ was the guarantor and designed the study; Qu GT, Teng YX, Li ZF, Nie XY and Liu DJ participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Li WD and Liu T revised the article critically for important intellectual content.
Supported by the Fundamental Scientific Research Project of Tianjin Universities of China, No. 2017KJ191.
Institutional review board statement: The study complied with the Declaration of Helsinki and was approved by the ethics committee of Tianjin Medical University General Hospital (Ethics approval number: IRB2022-WZ-167).
Informed consent statement: The need for informed consent was waived by the ethical committee of Tianjin Medical University General Hospital.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data from this study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE statement-checklist of items, and the manuscript was prepared and revised according to the STROBE statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Dong Li, Doctor, MD, PhD, Surgical Oncologist, Department of General Surgery, Tianjin General Surgery Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300000, China. tjmughgs_lwd@163.com
Received: October 3, 2022
Peer-review started: October 3, 2022
First decision: October 21, 2022
Revised: October 26, 2022
Accepted: November 30, 2022
Article in press: November 30, 2022
Published online: December 15, 2022
Processing time: 69 Days and 16.9 Hours
Abstract
BACKGROUND

Increasing evidence have shown that regional lymph node metastasis is a critical prognostic factor in gastric cancer (GC). In addition, lymph node dissection is a key factor in determining the appropriate treatment for GC. However, the association between the number of positive lymph nodes and area of lymph node metastasis in GC remains unclear.

AIM

To investigate the clinical value of regional lymph node sorting after radical gastrectomy for GC.

METHODS

This study included 661 patients with GC who underwent radical gastrectomy at Tianjin Medical University General Hospital between January 2012 and June 2020. The patients were divided into regional sorting and non-sorting groups. Clinicopathological data were collected and retrospectively reviewed to determine the differences in the total number of lymph nodes and number of positive lymph nodes between the groups. Independent sample t-tests were used for intergroup comparisons. Continuous variables that did not conform to a normal distribution were expressed as median (interquartile range), and the Mann-Whitney U test was used for inter-group comparisons.

RESULTS

There were no significant differences between the groups in terms of the surgical method, tumor site, immersion depth, and degree of differentiation. The total number of lymph nodes was significantly higher in the regional sorting group (n = 324) than in the non-sorting group (n = 337) (32.5 vs 21.2, P < 0.001). There was no significant difference in the number of positive lymph nodes between the two groups. A total of 212 patients with GC had lymph node metastasis in the lymph node regional sorting group, including 89 (41.98%) cases in the first dissection station and 123 (58.02 %) cases in the second dissection station. Binary and multivariate logistic regression results showed that the number of positive lymph nodes (P < 0.001) was an independent risk factor for lymph node metastases at the second dissection station.

CONCLUSION

Regional sorting of lymph nodes after radical gastrectomy may increase the number of detected lymph nodes, thereby improving the reliability and accuracy of lymph node staging in clinical practice.

Keywords: Radical gastrectomy; Regional lymph node sorting; Lymph node dissection; Lymph node staging; Metastasis; Gastric cancer

Core Tip: The lymph node metastasis rates of different groups of gastric cancer (GC) lymph nodes in different parts of GC differ. Understanding the mechanisms of lymph node metastasis to guide lymph node dissection during surgery is of great significance. Regional sorting of lymph nodes after radical gastrectomy for GC may increase the number of detected lymph nodes, thereby allowing a more accurate and reliable lymph node staging, which is helpful in clinical practice.