Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2021; 13(11): 1390-1404
Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1390
Risk of station 12a lymph node metastasis in patients with lower-third gastric cancer
Yin-Ping Dong, Feng-Lin Cai, Zi-Zhen Wu, Peng-Liang Wang, Yang Yang, Shi-Wei Guo, Zhen-Zhen Zhao, Fu-Cheng Zhao, Han Liang, Jing-Yu Deng
Yin-Ping Dong, Feng-Lin Cai, Zi-Zhen Wu, Peng-Liang Wang, Shi-Wei Guo, Zhen-Zhen Zhao, Fu-Cheng Zhao, Han Liang, Jing-Yu Deng, Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy at Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
Yang Yang, Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy at Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
Author contributions: Dong YP and Cai FL contributed equally to this work; Dong YP contributed to project development, data analysis, and manuscript writing and editing; Wu ZZ and Zhao ZZ contributed to project development; Cai FL, Wang PL, Yang Y, Guo SW, and Zhao FC contributed to data collection or management; Liang H contributed to protocol development and data collection or management; Deng JY contributed to protocol/project development, data collection or management, data analysis, and manuscript writing and editing.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Tianjin Medical University Cancer Institute and Hospital.
Informed consent statement: All eligible patients delivered written informed consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Yu Deng, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy at Tianjin, Tianjin’s Clinical Research Center for Cancer, Huanhuxi Road, Hexi District, Tianjin 300060, China. dengery@126.com
Received: April 7, 2021
Peer-review started: April 7, 2021
First decision: June 14, 2021
Revised: July 6, 2021
Accepted: October 24, 2021
Article in press: October 24, 2021
Published online: November 27, 2021
Processing time: 233 Days and 9.9 Hours
Abstract
BACKGROUND

Controversy over the issue that No. 12a lymph node involvement is distant or regional metastasis remains, and the possible inclusion of 12a lymph nodes in D2 lymphadenectomy is unclear. As reported, gastric cancer (GC) located in the lower third is highly related to the metastasis of station 12a lymph nodes.

AIM

To investigate whether the clinicopathological factors and metastasis status of other perigastric nodes can predict station 12a lymph node metastasis and evaluate the prognostic significance of station 12a lymph node dissection in patients with lower-third GC.

METHODS

A total of 147 patients with lower-third GC who underwent D2 or D2+ lymphadenectomy, including station 12a lymph node dissection, were included in this retrospective study from June 2003 to March 2011. Survival prognoses were compared between patients with or without station 12a lymph node metastasis. Logistic regression analyses were used to clarify the association between station 12a lymph node metastasis and clinicopathological factors or metastasis status of other perigastric nodes. The metastasis status of each regional lymph node was evaluated to identify the possible predictors of station 12a lymph node metastasis.

RESULTS

Metastasis to station 12a lymph nodes was observed in 18 patients with lower-third GC, but not in 129 patients. The incidence of station 12a lymph node involvement was reported as 12.2% in patients with lower-third GC. The overall survival of patients without station 12a lymph node metastasis was significantly better than that of patients with station 12a metastasis (P < 0.001), which could also be seen in patients with or without extranodal soft tissue invasion. Station 12a lymph node metastasis and extranodal soft tissue invasion were identified as independent predictors of poor prognosis in patients with lower-third GC. Advanced pN stage was defined as independent risk factor significantly correlated with station 12a lymph node positivity. Station 3 lymph node staus was also proven to be significantly correlated with station 12a lymph node involvement.

CONCLUSION

Metastasis of station 12a lymph nodes could be considered an independent prognosis factor for patients with lower-third GC. The dissection of station 12a lymph nodes may not be ignored in D2 or D2+ lymphadenectomy due to difficulties in predicting station 12a lymph node metastasis.

Keywords: Gastric cancer; Lymph node; Metastasis; No. 12a; Proper hepatic artery

Core Tip: The possible inclusion of 12a lymph nodes in D2 lymphadenectomy remains unclear. As reported, gastric cancer (GC) located in the lower third was highly related to the metastasis of station 12a lymph nodes. The clinicopathological factors related to station 12a lymph node metastasis in patients with lower-third GC were investigated. The results showed that station 3 lymph node status was highly related to station 12a lymph node metastasis. The poor prognosis of patients with station 12a lymph node metastasis compared with those without 12a indicated that station 12a lymph node dissection must be considered.