Indication of Proximal Gastrectomy for Advanced Proximal Gastric Cancer Based on Lymph Node Metastasis at the Distal Part of the Stomach

Objective: To suggest the possible indication of proximal gastrectomy for advanced gastric cancer located at the upper third of the stomach. Background: Proximal gastrectomy has been an alternative surgical procedure for early proximal gastric cancer due to its benefits for quality of life while maintaining oncological outcomes. However, the oncological safety of proximal gastrectomy for advanced tumors remains unclear. Methods: We retrospectively reviewed data from 878 patients who underwent radical total gastrectomy from 2003 to 2018 for pathologic T2–T4 gastric cancer in the upper third of the stomach. We identified risk factors for lymph node metastasis at the distal part of the stomach, which was not dissected in proximal gastrectomy. Subsequently, we evaluated the metastasis rate and therapeutic value index of lymph nodes at the distal part of the stomach in patients with none of these risk factors. Results: Multivariable analysis revealed that esophagogastric junction (EGJ)-tumor epicenter distance >30 mm, tumor size >70 mm, macroscopic type IV tumor, and serosal invasion were risk factors for lymph node metastasis at the distal stomach. In patients without risk factors, the therapeutic value index for any lymph nodes at the distal stomach was 0.8, suggesting that lymph node dissection could be omitted in these patients. Conclusions: EGJ-tumor epicenter distance ≤ 30 mm, tumor size ≤ 70 mm, not a macroscopic type IV tumor, and no serosal invasion could be an indication of proximal gastrectomy for advanced gastric cancer located at the upper third of the stomach.

[1]  H. Eguchi,et al.  Multicenter prospective trial of total gastrectomy versus proximal gastrectomy for upper third cT1 gastric cancer , 2020, Gastric Cancer.

[2]  Japanese Gastric Cancer Association.  Japanese gastric cancer treatment guidelines 2018 (5th edition) , 2020, Gastric Cancer.

[3]  Kazuhiro Yoshida,et al.  Mapping of Lymph Node Metastasis From Esophagogastric Junction Tumors , 2019, Annals of surgery.

[4]  Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach , 2019, Journal of gastric cancer.

[5]  T. Yoshikawa,et al.  Oncological safety of proximal gastrectomy for T2/T3 proximal gastric cancer , 2019, Gastric Cancer.

[6]  R. Makuuchi,et al.  Changes in body weight, skeletal muscle and adipose tissue after gastrectomy: a comparison between proximal gastrectomy and total gastrectomy , 2019, ANZ journal of surgery.

[7]  H. Katai,et al.  Can proximal Gastrectomy Be Justified for Advanced Adenocarcinoma of the Esophagogastric Junction? , 2018, Journal of gastric cancer.

[8]  M. Ooi,et al.  Should Pyloric Lymph Nodes Be Dissected for Siewert Type II and III Adenocarcinoma of the Esophagogastric Junctions: Experience from a High-Volume Center in China , 2018, Journal of Gastrointestinal Surgery.

[9]  A. Jemal,et al.  Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries , 2018, CA: a cancer journal for clinicians.

[10]  T. Son,et al.  Similar hematologic and nutritional outcomes after proximal gastrectomy with double-tract reconstruction in comparison to total gastrectomy for early upper gastric cancer , 2018, Surgical Endoscopy.

[11]  G. Costamagna,et al.  Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach: a propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer–GIRCG) , 2018, Gastric Cancer.

[12]  R. Makuuchi,et al.  Impact of Malnutrition After Gastrectomy for Gastric Cancer on Long-Term Survival , 2018, Annals of Surgical Oncology.

[13]  Y. Ohkura,et al.  Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer , 2017, Gastric Cancer.

[14]  T. Yoshikawa,et al.  Randomized Controlled Trial to Evaluate Splenectomy in Total Gastrectomy for Proximal Gastric Carcinoma , 2017, Annals of surgery.

[15]  S. Ida,et al.  Clinical Outcomes and Evaluation of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach , 2017, Annals of Surgical Oncology.

[16]  S. Shrikhande,et al.  Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary , 2016, Langenbeck's Archives of Surgery.

[17]  T. Yoshikawa,et al.  Distribution of involved abdominal lymph nodes is correlated with the distance from the esophagogastric junction to the distal end of the tumor in Siewert type II tumors. , 2015, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[18]  Y. Kodera,et al.  Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by Postgastrectomy Syndrome Assessment Scale (PGSAS-45): a nationwide multi-institutional study , 2015, Gastric Cancer.

[19]  Jinning Ye,et al.  Proximal gastric cancer: lymph node metastatic patterns according to different T stages dictate surgical approach , 2014, Chinese medical journal.

[20]  R. Makuuchi,et al.  The optimal extent of lymph node dissection for adenocarcinoma of the esophagogastric junction differs between Siewert type II and Siewert type III patients , 2014, Gastric Cancer.

[21]  Yanfeng Hu,et al.  Vitamin B12 Deficiency After Gastrectomy for Gastric Cancer: An Analysis of Clinical Patterns and Risk Factors , 2013, Annals of surgery.

[22]  Yanfeng Hu,et al.  Method of Reconstruction Governs Iron Metabolism After Gastrectomy for Patients With Gastric Cancer , 2013, Annals of surgery.

[23]  Y. Doki,et al.  Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study , 2013, Gastric Cancer.

[24]  H. Katai,et al.  Optimal Extent of Lymph Node Dissection for Siewert Type II Esophagogastric Junction Carcinoma , 2011, Annals of surgery.

[25]  A. Shabbir,et al.  Cancer of the Gastric Cardia is Rising in Incidence in an Asian Population and is Associated with Adverse Outcome , 2011, World Journal of Surgery.

[26]  J. Coebergh,et al.  Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: a population-based study in the Netherlands. , 2010, European journal of cancer.

[27]  K. Yamashita,et al.  Clinical significance of total gastrectomy for proximal gastric cancer. , 2008, Anticancer research.

[28]  Y. Mok,et al.  Surgical Outcomes for Gastric Cancer in the Upper Third of the Stomach , 2006, World Journal of Surgery.

[29]  S. Fushida,et al.  Evaluation of Residual Stomach Motility After Proximal Gastrectomy for Gastric Cancer by Electrogastrography , 2006, Digestive Diseases and Sciences.

[30]  C. Yoo,et al.  Long-term results of proximal and total gastrectomy for adenocarcinoma of the upper third of the stomach. , 2004, Cancer research and treatment : official journal of Korean Cancer Association.

[31]  Y. Kodera,et al.  Adenocarcinoma of the gastroesophageal junction in Japan: relevance of Siewert's classification applied to 177 cases resected at a single institution. , 1999, Journal of the American College of Surgeons.

[32]  M. Brennan,et al.  Total gastrectomy is not necessary for proximal gastric cancer. , 1998, Surgery.

[33]  D. Ichikawa,et al.  The operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach , 1997, Surgery Today.

[34]  R. Koller,et al.  Prognostic factors in adenocarcinoma of the cardia. , 1995, American journal of surgery.

[35]  M. Sasako,et al.  New method to evaluate the therapeutic value of lymph node dissection for gastric cancer , 1995, The British journal of surgery.

[36]  S. Msika,et al.  Carcinoma of the gastric cardia: Surgical management and long-term survival , 1988, World Journal of Surgery.

[37]  Sang-Hoon Ahn,et al.  Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer , 2013, Gastric Cancer.

[38]  Japanese Gastric Cancer Association.  Japanese classification of gastric carcinoma: 3rd English edition , 2011, Gastric Cancer.