The risk of lymph node metastasis in gastric cancer conforming to indications of endoscopic resection and pylorus-preserving gastrectomy: a single-center retrospective study

• Published in: BMC cancer 2021-11, Vol.21 (1), p.1280-1280, Article 1280
• Main Authors: Yanzhang, Wu, Guanghua, Li, Zhihao, Zhou, Zhixiong, Wang, Zhao, Wang
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Aged; Aged, 80 and over; Analysis of Variance; Antigens; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Complications and side effects; Disease-Free Survival; Early gastric cancer; Endoscopy; Female; Gastrectomy; Gastrectomy - methods; Gastric cancer; Gastrointestinal surgery; Gastroscopy; Humans; Incidence; Lymph node metastasis; Lymph nodes; Lymph Nodes - pathology; Lymphatic invasion; Lymphatic Metastasis; Lymphatic system; Male; Medical prognosis; Metastases; Metastasis; Middle Aged; Organ Sparing Treatments; Patients; Predictive model; Prognosis; Pylorus; Quality of life; Retrospective Studies; Risk Factors; Skip metastasis; Stomach cancer; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Survival; Survival analysis; Tumor Burden; Tumors; Young Adult
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-021-09008-8

Lymph node metastasis (LNM) status is an important prognostic factor that strongly influences the treatment decision of early gastric cancer (EGC). This study aimed to evaluate the pattern and clinical significance of LNM in EGC. A total of 354 patients with carcinoma in situ (n = 42), EGC (n = 312) who underwent radical gastrectomy were enrolled. Their clinicopathological features, pathological reports, and prognostic data were collected and analyzed. The incidence of LNM in all patients was 18.36% (65/354). The rates of D1 and D2 station metastases were 12.10% (43/354) and 6.21% (22/354), respectively. The rates of LNM in absolute indication of endoscopic resection and expanded indication were 3.27% (2/61) and 28.55% (4/14), respectively. Skip LNM was observed in 3.67% (13/354) of patients. For those with middle-third tumor, the metastasis rate of the No. 5 lymph node was 3.05% (5/164). The independent risk factors for LNM were tumors measuring > 30 mm, poorly differentiated tumors, and lymphovascular invasion (all P  20 mm and LNM were independent predictive factors for poor survival outcome in all patients. Patients with EGC conforming to expanded indications have a relatively high risk of LNM and may not be suitable for endoscopic submucosal dissection. Pylorus-preserving gastrectomy for patients with middle-third EGC remains controversial due to the high metastasis rate of the No. 5 lymph node.