Clinical Characteristics of Gastric Cancer with Metastasis to the Lymph Node along the Superior Mesenteric Vein (14v)

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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Reply to questions in response to “Improved Survival after Adding Dissection of the Superior Mesenteric Vein Lymph Node (14v) to Standard D2 Gastrectomy for Advanced Distal Gastric Cancer”

Surgery ◽

10.1016/j.surg.2014.04.041 ◽

2014 ◽

Vol 156 (3) ◽

pp. 737-738 ◽

Cited By ~ 2

Author(s):

Bang Wool Eom ◽

Jungnam Joo ◽

Boram Park ◽

Young-Woo Kim

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Superior Mesenteric Vein ◽

Mesenteric Vein ◽

D2 Gastrectomy ◽

Distal Gastric Cancer

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A CASE REPORT OF GASTRIC CANCER FORMING A TUMOR EMBOLUS IN THE SUPERIOR MESENTERIC VEIN

The journal of the Japanese Practical Surgeon Society ◽

10.3919/ringe1963.57.885 ◽

1996 ◽

Vol 57 (4) ◽

pp. 885-890 ◽

Cited By ~ 1

Author(s):

Tetsuya UEHARA ◽

Nobuyasu YAMASAKI ◽

Shigehiko YAGI ◽

Goro HONDA ◽

Toyotake OKANOUE ◽

...

Keyword(s):

Gastric Cancer ◽

Case Report ◽

Superior Mesenteric Vein ◽

Tumor Embolus ◽

Mesenteric Vein

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Isolated Superior Mesenteric Vein Tumor Thrombus in a Patient with Gastric Cancer

Case Reports in Surgery ◽

10.1155/2018/3648436 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Barış Özcan ◽

Metin Çevener ◽

Ayşegül Kargı ◽

Mustafa Özdoğan ◽

Alihan Gürkan

Keyword(s):

Gastric Cancer ◽

Portal Vein ◽

Tumor Thrombus ◽

Superior Mesenteric Vein ◽

Locally Advanced ◽

Hepatic Metastases ◽

Oral Feeding ◽

Mesenteric Vein ◽

Abdominal Disease ◽

Anastomosis Site

Tumor thrombus in the portal vein can rarely originate from gastric cancer via hematogenous spread, with only few case reports published in the literature. Isolated superior mesenteric vein tumor thrombus in gastric cancer has not been previously reported. A 61-year-old male patient who had undergone distal gastrectomy and gastroenterostomy for gastric ulcer 20 years ago was diagnosed with an obstructive tumor originating from the gastroenterostomy anastomosis site on upper gastrointestinal endoscopy that was performed for complaints of fatigue, oral feeding problems, and anemia. The PET-CT imaging revealed a hypermetabolic mass in the gastroenterostomy region along with hypermetabolic suspected tumor thrombus in the superior mesenteric vein (SMV). A suspected tumor thrombus with contrast enhancement that completely obstructed the SMV was detected on triphasic abdominal computed tomography. Decision for surgery was made due to gastric tumor obstruction. Firstly, lesions suspected with tumor thrombus were extirpated from the SMV and sent to frozen section. Then, it was completely recanalized. A locally advanced tumor originating from the gastroenterostomy anastomosis site that totally obliterated the lumen was observed on surgical exploration. After proving tumor thrombus by frozen, near-total gastrectomy was performed for palliative purposes. Histopathologic examination of the specimen showed gastric invasive adenocarcinoma and tumor thrombi in the SMV (T4N2M1). The patient received adjuvant chemotherapy, and he is at his 22nd-month follow-up with extensive hepatic metastases and intra-abdominal disease. It should be kept in mind that gastric cancer may lead to portal vein tumor thrombus or that it may rarely be associated with an isolated SMV tumor thrombus, both of which are associated with poor prognosis.

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