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
ARTICLE HIGHLIGHTS
Research background

In recent years, the morbidity and mortality of gastric cancer (GC) remain high worldwide. Its incidence ranks fifth among malignant tumors, and its mortality ranks fourth. The progression of GC involves direct tumor invasion, lymph node metastasis, and organ and peritoneal metastasis. Lymph node metastasis is one of the main ways of GC metastasis. Even in patients with early GC, 3% to 20% of patients with early GC can develop lymph node metastasis. Therefore, surgical dissection of lymph nodes is the key to the treatment of GC, and obtaining accurate lymph node staging is also a non-negligible part of the treatment of GC.

Research motivation

Accurate lymph node staging can evaluate the therapeutic effect of surgery, and can also provide a reliable basis for patients to choose subsequent treatment options. Since the current lymph node staging takes the number of metastatic lymph nodes as the staging standard, the number of detected lymph nodes in postoperative specimens of GC is particularly important.

Research objectives

To explore the clinical application value of lymph node region sorting after radical gastrectomy for GC, summarize the rules of lymph node metastasis in different parts of GC around the stomach, and further explore the relationship between the number of positive lymph nodes and the lymph node metastasis area.

Research methods

The clinicopathological data of patients who underwent radical gastrectomy for GC in the Gastrointestinal and Anorectal Surgery Department of Tianjin Medical University General Hospital from January 2012 to June 2020 were collected, and the number of lymph nodes, positive lymph nodes in the lymph node regional sorting group and the unsorted group were analyzed. Differences in the number of lymph nodes; GC patients who had undergone regional sorting were grouped according to tumor sites, and the lymph node metastasis rates in each group were statistically analyzed, and the relationship between the number of positive lymph nodes and the lymph node metastasis area was analyzed by logistic regression.

Research results

The number of lymph nodes sent for examination in the regional sorting group was more than that in the unsorted group (P < 0.001); there was no significant difference in the number of positive lymph nodes between the two groups (P = 0.863). The lymph nodes with higher metastasis rate in upper cancer were No. 3 group (31.48%), while No. 4 group (7.56%), No. 5 group (8.89%), and No. 6 group (7.14%). The lymph node metastasis rate is low; in the middle cancer, the lymph node metastasis rate is higher in each group; in the lower cancer, the lymph nodes with higher metastasis rate are No. 3 group (30.50%), No. 2 group (9.68%), No. 12a (9.75%) had low lymph node metastasis rate. The multivariate logistic regression results showed that the number of positive lymph nodes was positively correlated with the risk of lymph node metastasis in the second station dissection area.

Research conclusions

Regional lymph node sorting after radical gastrectomy for GC can increase the number of detected lymph nodes and make lymph node staging more accurate and credible, which is worthy of clinical implementation. The lymph node metastasis rates of different groups of GC lymph nodes in different parts of GC are different. It is of great significance to understand the rules of lymph node metastasis to guide the lymph node dissection during operation. With the increase of the number of positive lymph nodes, the site of lymph node metastasis spreads from the first-stage dissection area to the second-stage dissection area. Identifying the location of lymph node metastasis can make lymph node staging more accurate.

Research perspectives

The current lymph node staging has a certain degree of consistency with the location of lymph node metastasis. With the increase in the number of lymph node metastases, the location of lymph node metastasis spreads from the first-stage dissection area to the second-stage dissection area. Identifying the lymph node metastasis location can make lymph node staging more accurate. Optimization of lymph node staging by including lymph node metastases requires further study.