The Case for a More Conservative Surgery for Proximal Gastric Cancer
Menée en Corée à partir de données 2000-2015 portant sur 9 952 patients atteints d'un adénocarcinome gastrique (âge moyen : 57,7 ans ; 70,5 % d'hommes), cette étude analyse l'efficacité, du point de vue du taux de métastases ganglionnaires, et la sécurité d'une gastrectomie proximale
Gastric cancer is the third most common cause of cancer-related deaths worldwide. Although the overall incidence of gastric adenocarcinoma has declined in some countries, there has been a general increase of cancer involving the upper third of the stomach (proximal gastric cancer) along with an increase of adenocarcinoma of the esophagogastric junction. Surgical resection remains a cornerstone of gastric cancer treatment with curative intent, but the extension of gastric resection for patients with proximal gastric cancer is debated. This issue has been addressed in the study by Khalayleh et al, which examined the number and site of lymph node metastases with size and location of the tumor based on clinical staging in patients undergoing upfront total gastrectomy. The analysis of 655 patients with localized adenocarcinoma of the upper third of the stomach showed that for cT1-T3N0/N1 differentiated tumors and for cT1N0/N1 poorly differentiated tumors, there were no lymph node metastases in the suprapyloric (station 5) and infrapyloric nodes (station 6) as well as in the lymph nodes along the right greater curvature or right gastroepiploic artery (station 4d). The risk of lymph node metastases increased significantly for poorly differentiated tumors and when tumor size was 4.1 cm or greater (40.0% vs 20.4%, P = .001). According to these results, Khalayleh and colleagues suggest that proximal gastrectomy can be safely performed when a differentiated cT1-T3N0/N1 or poorly differentiated cT1N0/N1 gastric cancer less than 4.1 cm is diagnosed preoperatively.
JAMA Network Open , éditorial en libre accès, 2020