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Copyright ©The Author(s) 2016.
World J Gastrointest Surg. Apr 27, 2016; 8(4): 294-300
Published online Apr 27, 2016. doi: 10.4240/wjgs.v8.i4.294
Table 1 Anatomical definition of lymph node stations
Lymph node stationLabelAnatomical description
1Right paracardialRight paracardial LNs, including those along the first branch of the ascending limb of the left gastric artery
2Left paracardialLeft paracardial LNs including those along the esophagocardiac branch of the left subphrenic artery
3Lesser curvature3a: Along the branches of the left gastric artery
3b: Along the 2nd branch and distal part of the right gastric artery
4Left gastric curvature4sa: Left greater curvature LNs along the short gastric arteries (perigastric area)
4sb: Left greater curvature LNs along the left gastroepiploic artery (perigastric area)
Right greater curvature4d: Rt. greater curvature LNs along the 2nd branch and distal part of the right gastroepiploic artery
5SuprapyloricAlong the 1st branch and proximal part of the right gastric artery
6InfrapyloricAlong the first branch and proximal part of the right gastroepiploic artery down to the confluence of the right gastroepiploic vein and the anterior superior pancreatoduodenal vein
7Left gastric aretryAlong the trunk of left gastric artery between its root and the origin of its ascending branch
8Common hepatic artery8a: Anterosuperior LNs along the common hepatic artery
8p: Posterior LNs along the common hepatic artery
9CeliacAlong the coeliac artery
10Splenic hilumLymph nodes in the splenic hilum including those adjacent to the splenic artery distal to the pancreatic tail, and those on the roots of the short gastric arteries and those along the left gastroepiploic artery proximal to its 1st gastric branch
11Splenic artery11p: Proximal splenic artery LNs from its origin to halfway between its origin and the pancreatic tail end
11d: Distal splenic artery LNs from halfway between its origin and the pancreatic tail end to the end of the pancreatic tail
12Hepatoduodenal ligamant12a: Hepatoduodenal ligament LNs along the proper hepatic artery, in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas
12b: Hepatoduodenal ligament LNs along the bile duct, in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas
12p: Hepatoduodenal ligament LNs along the portal vein in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas
13Posterior pancreatic headOn the posterior surface of the pancreatic head cranial to the duodenal papilla
14vSuperior mesenteric veinAlong the superior mesenteric vein
15Middle colic vesselsAlong the middle colic vessels
16Para-aortic16a1: Paraaortic lymph nodes in the diaphragmatic aortic hiatus
16a2: Paraaortic lymph nodes between the upper margin of the origin of the celiac artery and the lower border of the left renal vein
16b1: Paraaortic lymph nodes between the lower border of the left renal vein and the upper border of the origin of the inferior mesenteric artery
16b2: Paraaortic lymph nodes between the upper border of the origin of the inferior mesenteric artery and the aortic bifurcation
17Anterior surface of pancreatic headOn the anterior surface of the pancreatic head beneath the pancreatic sheath
18Inferior border of the pancreatic bodyAlong the inferior border of the pancreatic body
19InfradiaphragmaticInfradiaphragmatic, predominantly along the subphrenic artery
20Paraesophageal, esophageal hiatusIn the diaphragmatic esophageal hiatus
110Paraesophageal, lower thoracicIn the lower thorax
111SupradiaphragmaticSupradiaphragmatic lymph nodes separate from the esophagus
112Posterior mediastinalPosterior mediastinal lymph nodes separate from the esophagus and the esophageal hiatus
Table 2 Previously published randomized clinical trials addressing the extent of lymphadenectomy in gastric cancer
Ref.Study periodStudy groupsMedian follow-upResultConclusion
Cuschieri et al[14]1986-1993D1 = 200, D2 = 2006.5 yr, overall5-yr OS in D1 vs D2 - 35% vs 33%, (HR = 1.10, 95%CI: 0.87-1.39)Classical Japanese D2 resection offers no survival advantage over D1 surgery
Songun et al[13]1989-1993D1 = 380, D2 = 33115.2 yr, overall5-yr OS D1 vs D2 - 21% vs 29%, (log-rank P = 0.34), subgroup analysis of patients without pancreatico-splenectomy, 15-yr OS in D1 vs D2 = 22% vs 35% (HR = 1.34, 95%CI: 1.09-1.65; log-rank P = 0.006)Spleen preserving D2 resection should be recommended as the standard surgical approach to resectable gastric cancer
Degiuli et al[17]1998-2006D1 = 133, D2 = 1346.7 yr, overall5-yr OS in two arms D1 vs D2 - 66.5% vs 64.2%, (difference -2.3, 95%CI: -14.0 to 9.3; P = 0.695), 5-yr disease-specific survival in pathological tumour pT2-4 in two arms D1 vs D2 - 38% vs 59%; P = 0.055No difference in overall 5-yr survival between D1 and D2 resection; D2 lymphadenectomy may be a better choice in patients with advanced disease and lymph node metastases
Wu et al[19]1993-1999D1 = 110, D3 = 11194.5 mo, for survivors5-yr OS in D1 vs D3 - 53.6% vs 59.5% difference between groups 5.9% (95%CI: -7.3 to 19.1), log-rank P = 0.041)D3 dissection offers a survival benefit for patients with gastric cancer compared with D1 dissection
Sasako et al[21]1995-2001D2 = 260, D2 + PAND = 2635.6 yr for D2 lymphadenectomy alone and 5.7 yr for D2 lymphadenectomy plus PAND 94.5 mo, for survivors5-yr overall survival rate for D2 vs D2 + PAND -69.2% vs 70.3% HR for death 1.03 (95%CI: 0.77-1.37; P = 0.85)No survival benefit with D2 lymphadenectomy plus PAND in curable gastric cancer as compared with D2 lymphadenectomy alone
Yonemura et al[22]1995-2002D2 = 135, D2 + PAND = 134NS5-yr overall survival rate for D2 vs D2 + PAND -52.6% vs 55.0% (χ2 = 0.064; P = 0.801)Prophylactic D4 dissection is not recommended for patients with potentially curable advanced gastric cancer
Kulig et al[20]1999-2003D2 = 141, D2 + PAND = 134Results awaitedResults awaitedResults awaited