Oncological Risk of Proximal Gastrectomy for Proximal Advanced Gastric Cancer After Neoadjuvant Chemotherapy

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2024 Feb 23

PMID 38395845

Authors

Yonghe Chen

Xiaojiang Chen

Yi Lin

Shenyan Zhang

Zhiwei Zhou

Junsheng Peng

Affiliations

Soon will be listed here.

Abstract

Purpose: This study assesses the metastasis rate of the key distal lymph nodes (KDLN) that are not routinely dissected in proximal gastrectomy, aiming to explore the oncological safety of proximal gastrectomy for upper gastric cancer who underwent neoadjuvant chemotherapy.

Methods: We analyzed a cohort of 150 patients with proximal locally advanced gastric cancer (cT3/4 before chemotherapy) from two high-volume cancer centers in China who received preoperative neoadjuvant chemotherapy (NAC) and total gastrectomy with lymph node dissection. Metastasis rate of the KDLN (No.5/6/12a) and the risk factors were analyzed.

Results: Key distal lymph node metastasis was detected in 10% (15/150) of patients, with a metastasis rate of 6% (9/150) in No. 5 lymph nodes, 6.7% (10/150) in No. 6 lymph nodes, and 2.7% (2/75) in No. 12a lymph nodes. The therapeutic value index of KDLN as one entity is 5.8. Tumor length showed no correlation with KDLN metastasis, while tumor regression grade (TRG) emerged as an independent risk factor (OR: 1.47; p-value: 0.04). Of those with TRG3 (no response to NAC), 80% (12/15) was found with KDLN metastasis.

Conclusion: For cT3/4 proximal locally advanced gastric cancer patients, the risk of KDLN metastasis remains notably high even after NAC. Therefore, proximal gastrectomy is not recommended; instead, total gastrectomy with thorough distal lymphadenectomy is the preferred surgical approach.

Citing Articles

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Prognosis and Treatment of Gastric Cancer: A 2024 Update.

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Correction: Oncological risk of proximal gastrectomy for proximal advanced gastric cancer after neoadjuvant chemotherapy.

Chen Y, Chen X, Lin Y, Zhang S, Zhou Z, Peng J BMC Cancer. 2024; 24(1):314.

PMID: 38448865 PMC: 10918980. DOI: 10.1186/s12885-024-12066-3.

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