Upper lesser curvature skeletonization in radical distal gastrectomy

• Published in: The Journal of surgical research 2015-01, Vol.193 (1), p.168-175
• Main Authors: Chen, Xin-Zu, MD, PhD, Zhang, Wei-Han, MD, Chen, Xiao-Long, MD, PhD, Liu, Kai, MD, Yang, Kun, MD, PhD, Zhou, Zong-Guang, MD, PhD, FACS, Hu, Jian-Kun, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Gastrectomy; Gastrectomy - mortality; Gastrectomy - statistics & numerical data; Gastric cancer; Humans; Lesser curvature; Logistic Models; Lymph Node Excision - mortality; Lymph Node Excision - statistics & numerical data; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphadenectomy; Lymphatic Metastasis; Male; Middle Aged; Multivariate Analysis; Neoplasm Grading; Retrospective Studies; Risk Factors; Standard technique; Stomach - surgery; Stomach Neoplasms - mortality; Stomach Neoplasms - secondary; Stomach Neoplasms - surgery; Surgery
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2014.07.035

Abstract Background To investigate the metastatic status of lymph nodes numbers (no.) 1, 3a, and 3b groups in radical distal gastrectomy with upper lesser curvature skeletonization and the risk factors for lesser curvature regional node (LCRN) metastasis. Methods Data on patients who underwent radical distal gastrectomy were retrospectively collected between May 2010 and September 2013. Clinicopathologic features and surgical outcomes were compared between the LCRN (+) and (−) groups. The correlations among the no. 1, 3a and 3b groups, and other groups were analyzed. Univariate and multivariate analyses were performed to identify the independent risk factors for LCRN metastasis. Results A total of 112 patients were analyzed. In all, 45.5% had metastatic LCRNs, and 59.8% were node positive overall. The LCRN (+) and (−) groups had significantly different features, including gender; tumor size; histologic grade; Lauren classification; gross type; and T, N, and TNM stages. The positivity rates of the no. 1, 3a, and 3b groups were 4.5%, 38.4%, and 32.1%, respectively, and the no. 1, 3a, and 3b groups were comprehensively correlated with the D2-tier groups. In the univariate and multivariate analyses, only stage T3–4 and positive no. 4d nodes were documented as independent risk factors, whereas no. 5 and 11p nodes trended toward a positive correlation. Conclusions LCRNs have high frequencies of metastasis in lower gastric cancers, and in the present study, these groups of lymph nodes tended to be associated with each other as an entity in the lesser curvature region. Upper lesser curvature skeletonization can be recommended as a standard procedure in radical distal gastrectomy to thoroughly clear the gastric stump, especially in the case of stage T3–4 or suspicious no. 4d nodes.