Questions in response to “Improved survival after adding dissection of the superior mesenteric vein lymph node in advanced distal gastric cancer”

Abstract Background: The validity of lymphadenectomy of the lymph node along the superior mesenteric vein (LN14v) in gastric cancer remains controversial. The study investigated the characteristics and prognosis of gastric cancer with metastasis or micrometastasis to LN14v.Methods: A retrospective study of 626 patients receiving radical gastrectomy in our center from January 2003 to December 2015 was analyzed. Totally, 303 patients receiving lymphadenectomy of 14v and lymph node micrometastasis was evaluated by immunohistochemical staining for cytokeratinnodes CK8/18. Logistic regression model was applied to confirm the predictive factors of micrometastasis. Survival analysis was performed to evaluate the effect of micrometastasis or metastasis on prognosis.Results: The metastastic rate of No.14v lymph node was 15.8% and the micrometastatic rate was 3.9%. Multivariate analysis showed site, Borrmann classification, postoperative lymph node metastasis (pN), the metastasis of LN6 and LN9 were predictive factors of LN14v micrometastasis or metastaticsis (P<0.05). The 5-year survival rate of positive group (14v micrometastasis or metastasis) was 12.4%. The prognosis of patients without micrometastatic 14v lymph node was better than positive group. While the difference between group of LN14v micrometastasis and LN14v metastasis was not obvious. In matched analysis, patients with gastric cancer of stage Ⅲ, U/M area, pN2-3 and LN 6(+) underwent lymphadenectomy of 14v suffered better survival than those without lymphadenectomy of 14v. Conclusion: Lymph node micrometastasis could provide accurate prognostic information for patients with GC. Thus, lymphadenectomy of LN14v should be recommended for patients with gastric cancer of stage Ⅲ, U/M area, pN2-3 and LN 6(+).

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Clinical Significance of Metastasis or Micrometastasis to the Lymph Node Along the Superior Mesenteric Vein in Gastric Carcinoma: A Retrospective Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.707249 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xing Xu ◽

Guoliang Zheng ◽

Tao Zhang ◽

Yan Zhao ◽

Zhichao Zheng

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Predictive Factors ◽

Superior Mesenteric Vein ◽

Stage Iii ◽

Prognostic Information ◽

Positive Group ◽

Mesenteric Vein ◽

Lymph Node Micrometastasis ◽

The Difference

BackgroundThe validity of lymphadenectomy of the lymph node along the superior mesenteric vein (LN14v) in gastric cancer remains controversial. The study investigated the characteristics and prognosis of gastric cancer with metastasis or micrometastasis to LN14v.MethodsA retrospective study of 626 patients undergoing radical gastrectomy in our center from January 2003 to December 2015 was analyzed. In total, 303 patients had lymphadenectomy of LN14v, and lymph node micrometastasis was evaluated by immunohistochemical staining for cytokeratin nodes CK8/18. A logistic regression model was applied to confirm the predictive factors of micrometastasis. Survival analysis was performed to evaluate the effect of micrometastasis or metastasis on prognosis.ResultsThe metastatic rate of the LN14v lymph node was 15.8%, and the micrometastatic rate was 3.3%. Multivariate analysis showed site, Borrmann classification, postoperative lymph node metastasis (pN), and metastasis in LN6 and LN9 were predictive factors for LN14v micrometastasis or metastasis (P < 0.05). The 5-year survival rate in the positive group (LN14v micrometastasis or metastasis) was 12.4%. The prognosis of patients without LN14v lymph node micrometastasis was better than that of the positive group, whereas the difference between group of LN14v micrometastasis and LN14v metastasis was not obvious. In matched analysis, patients with stage III gastric cancer L/M area, pN2-3, and LN6(+) who underwent lymphadenectomy of LN14v had better survival than those without lymphadenectomy of LN14v.ConclusionLymph node micrometastasis may provide accurate prognostic information for patients with gastric cancer. Moreover, lymphadenectomy of LN14v might improve the survival of patients with stage III gastric cancer of L/M area, pN2-3, and LN6(+).

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Analysis of Intestinal Flora and Levels of Epidermal Growth Factor Receptor, Interleukin-32, and Gastrin 17 in Patients with Gastric Cancer via Carbon Nanoparticle Laparoscopy

BioMed Research International ◽

10.1155/2021/6697597 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Liping Bai ◽

Fubing Yu ◽

Lixian Bai ◽

Yinhui Zhang ◽

Zhi Li ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Intestinal Flora ◽

Growth Factor Receptor ◽

Serum Levels ◽

Control Group ◽

Carbon Nanoparticle ◽

Laparoscopic Operation ◽

Distal Gastric Cancer ◽

Experimental Group

In order to explore the changes of intestinal flora and serum levels of relevant substances in patients with gastric cancer before and after surgery with carbon nanoparticle laparoscopy, a total of 180 patients with early distal gastric cancer who adopted laparoscopic radical gastrectomy for distal gastric cancer in the general surgery department of TCM Hospital of Shi Jia Zhuang City from January 2018 to January 2020 were selected and randomly divided into two groups: traditional laparoscopic operation (control group) and carbon nanoparticle laparoscopic operation (experimental group) were adopted for treatment for the two groups, respectively. Postoperative evaluation included the difference between the two groups in the operative time, the efficiency of intraoperative lymph node dissection, and the number of lymph node detection. The adverse reactions, changes of intestinal flora before and after surgery in the two groups, and the serum levels of epidermal growth factor receptor (EGFR), interleukin-32 (IL-32), and gastrin 17 were evaluated. In the experimental group, the success rate of carbon nanoparticle tracer black staining reached 100%, and the operation time of the experimental group was significantly shorter than that of the control group ( P < 0.05 ). The lymph node detection rate of the experimental group was higher than that of the control group ( P < 0.05 ), but there was no significant difference in the lymph node metastasis rate between the two groups ( P > 0.05 ). The sentinel lymph node sensitivity of the experimental group reached 92.3%, and the specificity, accuracy, and positive and negative prediction rates reached 100%; the experimental group patients were with an obviously higher incidence of level I-II gastrointestinal reaction ( P < 0.05 ). Postoperative increases in Bifidobacteria and Lactobacillus were observed in both groups, while decreases in Enterococcus and Escherichia coli were observed in both groups ( P < 0.05 ). Moreover, the degree of increase and decrease in the experimental group was greater than that in the control group ( P < 0.05 ). The serum levels of EGFR, IL-32, and gastrin 17 in the two groups were significantly lower than those in the control group on 3 d, 7 d, and 15 d after surgery ( P < 0.05 ). In the radical gastrectomy for distal gastric cancer, carbon nanoparticle laparoscopy was not only helpful for the localization of small tumors but also for the thorough dissection of lymph nodes after the surgery, and the postoperative adverse reactions of carbon nanoparticle laparoscopy were also less, which was of great significance for the improvement of intestinal flora and the reduction of serum levels of EGFR, IL-32, and gastrin 17 in gastric cancer patients.

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