Which patients with advanced, proximal gastric cancer benefit from complete clearance of spleno-pancreatic lymph nodes?
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.
Kikuchi
Shiro
S
Department of Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Sagamihara-shi, Kanagawa 228, Japan.
Nemoto
Yuhta
Y
Natsuya
Katada
K
Sakuramoto
Shinichi
S
Kobayashi
Nobuyuki
N
Shimao
Hitoshi
H
Sakakibara
Yuzuru
Y
Kakita
Akira
A
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