title: Evaluation of skeletonization of the hepatoduodenal ligament for the lower third gastric cancer by propensity score analysis.
abstract: OBJECTIVE
  Effects and indications of no. 12b and 12p nodes dissection for gastric cancer are not determined yet. Here we retrospectively evaluated the effect of no. 12b and 12p nodes dissection for treatment of lower third gastric cancer (LTGC).
  
  
  METHODS
  Between 2001 and 2010, 110 LTGC patients with no. 12b and 12p nodes dissection (SHDL group) and 138 patients without no. 12b and 12p nodes dissection (non-SHDL group) were enrolled in this study. Clinicopathological features and prognostic data were compared between the two groups.
  
  
  RESULTS
  The nodal metastatic rate was 8.2% of no. 12b and 10.9% of no. 12p. The 5-year survival rate was 62.9% in the SHDL group and 51.4% in the non-SHDL group (p = 0.16). Multivariate analysis with and without propensity score adjustment showed that SHDL was a significantly prognostic factor. The hazard ratio for death after D2 surgery plus SHDL was 0.457 (95% CI: 0.25 to 0.821; p = 0.0085) compared to D2 surgery alone. More patients in the non-SHDL group had only lymph node recurrence compared to the SHDL group (4.3% vs. 0%, p = 0.035).
  
  
  CONCLUSIONS
  Skeletonization of the hepatoduodenal ligament is associated with superior outcomes for LTGC patients especially for those with involved local hepatoduodenal nodes.
authors.forename: Zhe-Wei
authors.initials: ZW
authors.lastname: Wei
authors.forename: Guang-Kai
authors.initials: GK
authors.lastname: Xia
authors.forename: Ying
authors.initials: Y
authors.lastname: Wu
authors.forename: Roderich E
authors.initials: RE
authors.lastname: Schwarz
authors.forename: David D
authors.initials: DD
authors.lastname: Smith
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: He
authors.forename: Chang-Hua
authors.initials: CH
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008022:Ligaments / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome