Efficacy of D2 plus lymph node dissection for gastric cancer
Menée à partir de données portant sur 373 patients atteints d'un cancer de l'estomac de stade localement avancé, cette étude évalue l’efficacité et les indications optimales d'un curage ganglionnaire D2+
Background: Locally advanced gastric cancer is usually treated with D2 lymphadenectomy, although extended D2+ dissection (Nos. 12b, 12p, 13, and 14v) is occasionally performed. This study evaluated the efficacy and optimal indications for D2+ lymphadenectomy based on the therapeutic value index (TVI).
Materials and Methods: Patients undergoing curative gastrectomy with D2+ lymphadenectomy (n = 373) were retrospectively analyzed. The TVI for each station was calculated by multiplying the metastatic rate by the 5‐year survival rate. Factors associated with lymph node metastasis were identified via multivariate logistic regression analysis.
Results: The metastatic rate and TVI, respectively, were 8% and 2.6 for No. 12b/12p, 8 % and 2.4 for No. 13, and 7% and 3.9 for No. 14v. Higher TVIs were seen among patients with duodenal invasion versus those without (No. 12b/12p, 3.9 vs. 0; No. 13, 3.8 vs. 0; No. 14v, 9.0 vs. 2.7). On multivariate analysis, preoperative duodenal invasion (odds ratio 2.59 [95% confidence interval, 1.06–6.31]; p = 0.037) and clinical No. 6 metastasis (odds ratio 3.96 [95% confidence interval, 1.63–9.63]; p = 0.002) were independent predictors of No. 14v involvement.
Conclusions: Dissection of Nos. 12b, 12p, and 13 may be beneficial in patients with duodenal invasion. No. 14v dissection should be considered in patients with clinical No. 6 involvement or duodenal invasion.
European Journal of Surgical Oncology , résumé, 2025