title: Which patients with advanced, proximal gastric cancer benefit from complete clearance of spleno-pancreatic lymph nodes?
abstract: BACKGROUND
  The prognostic significance of dissecting spleno-pancreatic nodes remains unclear in patients with advanced proximal gastric cancer.
  
  
  METHODS
  Data from a total of 104 patients (74 males and 30 females; age range, 21 to 76 years; mean, 56.0 years), who had undergone curative total gastrectomy combined with spleno-pancreatectomy for advanced proximal gastric cancer, were analyzed with respect to clinicopathological features and patient survival.
  
  
  RESULTS
  Metastases to spleno-pancreatic nodes were found in 24 patients (23.1%). Tumor size > 40 mm (p = 0.0218), histologically-undifferentiated type (p = 0.0346) and both Japanese and TNM node-stages (p < 0.0001) were associated with metastases to these nodes. The 5-year survival rate of patients with a T2 tumor was 65.4% in patients with no metastases to the spleno-pancreatic nodes and 45.5% in patients with metastases to these nodes (p = 0.0699). No patients with a T3 tumor and metastases to the spleno-pancreatic nodes survived more than 4 years.
  
  
  CONCLUSIONS
  Complete clearance of SP-nodes for patients with advanced proximal gastric cancer is beneficial for patients with a T2 tumor but not for patients with a T3 tumor. Metastases to these nodes appear to be rare in tumors less than 40 mm. Thus, this treatment should not be routinely performed in patients with proximal advanced gastric cancer. It should not be considered in patients with T3 tumors or with tumors < or = 40 mm.
authors.affiliation: Department of Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Sagamihara-shi, Kanagawa 228, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Kikuchi
authors.forename: Yuhta
authors.initials: Y
authors.lastname: Nemoto
authors.forename: Katada
authors.initials: K
authors.lastname: Natsuya
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sakuramoto
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shimao
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Sakakibara
authors.forename: Akira
authors.initials: A
authors.lastname: Kakita
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010179:Pancreas; D011379:Prognosis; D013154:Spleen; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate