Clinical characteristics of gastric cancer with metastasis to the lymph node along the superior mesenteric vein (14v).
OBJECTIVE
We investigated the clinical significance of metastasis to the lymph node (LN) along the superior mesenteric vein (14v) in gastric cancer.


METHODS
A retrospective study of 2,513 gastrectomy patients with a 14v dissection was done using the Ganken Igan Database.


RESULTS
The incidence of 14v metastasis correlated with tumor location, depth of tumor invasion, regional LN metastases, peritoneal metastasis, peritoneal cytology-positive, hepatic metastasis and postoperative recurrence (p < 0.01). Metastases to the infra-pyloric LN (6), supra-pyloric LN (5) and left para-cardial LN (2) were independent variables affecting 14v metastasis (p < 0.05), and the 6 status was a useful predictive factor for a 14v-negative status with a low false-negative rate (1.9%). The patients with 14v metastasis after curative surgery demonstrated a significantly lower survival rate than those without (5-year overall survival rate; 11.3 vs. 60.2%, p < 0.0001). In them, LN around the abdominal aorta (16)-positive group showed a significantly lower survival rate than the negative group (p < 0.05).


CONCLUSIONS
Advanced gastric cancer with invasion to the lower stomach often metastasizes to 14v, and the 6 status can predict 14v negative. Most patients with 14v metastasis have a poor prognosis, similar to those with systemic metastasis, although some such patients may benefit from a curative dissection.
Masuda
Taka-aki
TA
Department of Gastroenterological Surgery, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan. takaakimas@ybb.ne.jp
Sakaguchi
Yoshihisa
Y
Toh
Yasushi
Y
Aoki
Yoshiro
Y
Harimoto
Norifumi
N
Taomoto
Junya
J
Ikeda
Osamu
O
Ohga
Takefumi
T
Adachi
Eisuke
E
Okamura
Takeshi
T
D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008499:Medical Records; D008642:Mesenteric Veins; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*