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©The Author(s) 2020.
World J Clin Cases. Jul 6, 2020; 8(13): 2703-2716
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2703
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2703
Table 1 Analysis of clinicopathologic characteristics relevant to para-aortic lymph node metastasis
Ref. | Year | Article type | Clinicopathologic characteristics relevant to para-aortic lymph node metastasis | ||||||
Perigastric nodal status | Tumor site (located in the U) | Tumor size ≥ 5 cm | Depth of tumor invasion | N stage of N2 and N3 | Macroscopic type Borrmann III/IV | Diffuse/mixed histology | |||
Takashima et al[11] | 2005 | Review | — | Yes | — | Yes | — | — | — |
Lee et al[54] | 2006 | Article | — | — | — | Yes | — | — | Yes |
Nomura et al[24] | 2007 | Article | No. 7 | — | Yes | — | Yes | — | Yes |
Chen et al[42] | 2009 | Meta-analysis | No. 7, 8 | — | — | Yes | — | — | — |
Hu et al[44] | 2009 | Article | No. 8a, 9 | — | — | — | — | — | — |
Fujimura et al[34] | 2009 | Article | — | Yes | — | — | — | — | — |
Tokunaga et al[31] | 2010 | Article | — | — | — | — | Yes | Yes | — |
Roviello et al[21] | 2010 | Article | — | Yes | — | — | — | — | — |
de Manzoni et al[28] | 2011 | Article | No. 1, 3, 7, 8a, 9 | Yes | — | Yes | — | — | Yes |
Wang et al[43] | 2013 | Article | No. 9 | Yes | — | — | Yes | Yes | — |
Zhou et al[42] | 2013 | Meta-analysis | No. 1, 3, 7, 9 | Yes | Yes | Yes | Yes | Yes | Yes |
Zhang et al[53] | 2014 | Article | — | — | — | Yes | Yes | — | — |
Liang et al[45] | 2016 | Review | No. 9 | Yes | — | — | Yes | Yes | — |
Douridas et al[47] | 2018 | Mini review | — | Yes | Yes | Yes | — | Yes | Yes |
Table 2 Some reported series of gastrectomy and a comparison of morbidity, mortality and survival between D2 and D2 + PAND
Ref. | Year | Countries and continents | Number of patients registered | Number of patients underwent D2 + PAND or D2+ | Incidence of PAN (%) | Prognosis differences between D2 vs D2 + PADN (D2+) | |||||||||||
Morbidity | Mortality | Recurrence rate | 5-yr survival rate | ||||||||||||||
D2 (%) | D2 + PAND (%) | P value | D2 (%) | D2 + PAND (%) | P value | D2 (%) | D2 + PAND (%) | P value | D2 (%) | D2 + PAND (%) | P value | ||||||
Günther et al[18] | 2000 | Turkey | 459 | 75 | — | 31.5 | 34.2 | — | 6.8 | 1.3 | — | — | — | — | — | — | — |
Bostanci et al[19] | 2004 | Turkey | 134 | 34 | — | 10 | 35.3 | < 0.05 | 1 | 8.8 | < 0.05 | — | — | — | — | — | — |
Sano et al[30] | 2004 | Japan | 523 | 260 | — | 20.9 | 28.1 | 0.067 | 0.8 | 0.8 | — | — | — | — | — | — | — |
Marrelli et al[17] | 2007 | Italy | 330 | 79 | 13.9 | 27 | 27 | 0.929 | 4 | 4 | 0.82 | — | — | — | — | — | — |
Kunisaki et al[55] | 2006 | Japan | 580 | 150 | — | — | — | — | — | — | — | 40 | 50 | 0.3538 | 56.0 | 50.4 | 0.9899 |
Kulig et al[20] | 2007 | Poland | 275 | 134 | — | 27.7 | 21.6 | 0.24 | 4.9 | 2.2 | 0.37 | — | — | — | — | — | — |
Sasako et al[37] | 2008 | Japan | 523 | 260 | 8.5 | — | — | — | — | — | — | — | — | — | 69.2 | 70.3 | — |
Yonemura et al[40] | 2008 | Japan | 293 | 134 | 9.0 | — | — | — | — | 3.7 | 0.12 | 46.7 | 38.8 | — | 52.6 | 55.0 | 0.801 |
Hu et al[44] | 2009 | China | 117 | 62 | 8.1 | 27.3 | 24.2 | 0.703 | 1.8 | 0 | 0.470 | — | — | — | 66.1 | 65.8 | 0.946 |
Roviello et al[21] | 2010 | Italy | 286 | 286 | 12.9 | — | 28 | — | — | 2.1 | — | — | — | — | — | 52.2 | — |
Tokunaga et al[31] | 2010 | Japan | 178 | 178 | - | — | 30 | — | — | 2 | — | — | — | — | — | 13 | — |
de Manzoni et al[28] | 2011 | Italy | 294 | 294 | 16 | — | — | — | — | — | — | — | — | — | — | — | — |
Zhang et al[53] | 2014 | China | 157 | 69 | 40.6 | — | — | — | 12.5 | 21.7 | 0.122 | 43.2 | 39.1 | 0.628 | 31.8 | 43.7 | 0.044 |
de Manzoni et al[78] | 2015 | Italy | 568 | 294 | 11.6 | — | — | — | 4 | 2.4 | 0.340 | 45.3 | 46.3 | 0.866 | — | — | — |
Table 3 Main studies that reported clinical data including survival outcomes following chemotherapy and surgery in patients with pathological positivity of para-aortic lymph nodes
Ref. | Registration number | Types of clinical trials (Phase I/II/III) | Published year | Time of accrual | Chemotherapy regimens | Followed by surgery | Extent of lymphadenectomy | Number of patients registered | Incidence of PAN (%) | Primary endpoint | R0 resection rate | Response rate | Survival rate | TRD | |||
Clinical | Pathological | Relapse-free survival | 3-yr (%) | 5-yr (%) | |||||||||||||
Yoshikaw et al[61] | JCOG0001 | II | 2009 | 2000-2003 | CPT-11/CDDP | Yes | D2 + PAND | 55 | 54.5 | 3-yr survival rate TRD rate | 65 (95%CI 51-78) | 56 | 15 | — | 27 | NA | 3/55 |
Oyama et al[60] | — | — | 2012 | 1990-2008 | S-1/CDDP/docetaxel | Yes | D2 + PAND | 44 | 100 | — | — | — | 87.5 | 75 (2-yr) | — | — | 0/44 |
Wang et al[64] | — | II | 2014 | 2008-2013 | XELOX (capecitabine and oxaliplatin) | Yes | D2 | 48 | 100 | Response rate of NAC | 50% | 85.1 | 49 | — | — | — | — |
Tsuburayaet al[33] | JCOG0405 | II | 2014 | 2005-2007 | S-1/CDDP | Yes | D2 + PAND | 51 | 51 | R0 resection rate | 82(95%CI 69-92) | 65 | 51 | — | 59 | 53 | 0/51 |
Ito et al[62] | JCOG1002 | II | 2017 | 2011-2013 | S-1/CDDP/docetaxel | Yes | D2 + PAND | 52 | 43.4 | Response rate (RECISTver.1.0) | 84.6 | 57.7 | 50 | — | — | — | 0/52 |
Takahari et al[63] | JCOG1002 | II | 2019 | 2011-2013 | S-1/CDDP/docetaxel | Yes | D2 + PAND | 52 | 43.4 | Clinical RR | — | — | 34.6 | 47.7 (5-yr) | 62.7 | 54.9 | 0/52 |
Table 4 Adverse effects in three Japanese prospective randomized trials exploring neoadjuvant chemotherapy plus surgery for patients with extensive lymph node metastasis (Para-aortic lymph nodes metastasis or bulky lymph nodes)
Adverse effect | JCOG0001[61] | JCOG0405[33] | JCOG1002[62,63] |
Grade 3/4 toxicity from chemotherapy | |||
Leucopenia | 31% | 4% | 18.9% |
Neutropenia | 55% | 19% | 39.6% |
Anemia | 24% | 13% | 7.5% |
Febrile neutropenia | 16% | 2% | 5.7% |
Thrombocytopenia | — | 4% | 1.9% |
Hyponatremia | — | — | 15.1% |
Hypokalemia | — | — | 5.7% |
Anorexia | — | 10% | 9.4% |
Vomiting | 13% | — | — |
Chemotherapy-related mortality | 2/55 | 0/51 | 0/52 |
Surgical complications | |||
Leakage | 1/49 | 3/49 | 2/49 |
Pancreatic fistula | 6/49 | 11/49 | 9/49 |
Abdominal abscess | 2/49 | 8/49 | — |
Pneumonia | 2/49 | 2/49 | 4/49 |
Wound infection | 2/49 | 0/49 | 2/49 |
Anastomotic stenosis | 1/49 | 0/49 | 1/49 |
Intestinal obstruction | 0/49 | 0/49 | 2/49 |
Cardiac failure | 1/49 | — | — |
Renal dysfunction | 1/49 | — | — |
Atelectasis | — | 3/49 | — |
Abdominal infection | — | — | 5/49 |
Pleural effusion | — | — | 6/49 |
Chylous ascites | — | — | 3/49 |
Delayed gastric emptying | — | — | 1/49 |
Thromboembolic event | — | 2/49 | 2/49 |
Other | 6/49 | 11/49 | — |
Postoperative mortality | 1/49 | 0/49 | 0/49 |
- Citation: Dong YP, Deng JY. Advances in para-aortic nodal dissection in gastric cancer surgery: A review of research progress over the last decade. World J Clin Cases 2020; 8(13): 2703-2716
- URL: https://www.wjgnet.com/2307-8960/full/v8/i13/2703.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v8.i13.2703