Reappraise role of No. 10 lymphadenectomy for proximal gastric cancer in the era of minimal invasive surgery during total gastrectomy: a pooled analysis of 4 prospective trial

作者：Zhong, Qing; Chen, Qi-Yue; Xu, Yan-Chang; Zhao, Gang; Cai, Li-Sheng; Li, Guo-Xin; Xu, Ze-Kuan; Yan, Su; Wu, Zu-Guang; Xue, Fang-Qin; Sun, Yi-Hong; Xu, Dong-Po; Zhang, Wen-Bin; Wan, Jin; Yu, Pei-Wu; Hu, Jian-Kun; Su, Xiang-Qian; Ji, Jia-Fu; Li, Zi-Yu; You, Jun; Li, Yong; Fan, Lin; Zheng, Chao-Hui; Xie, Jian-Wei; Li, Ping; Huang, Chang-Ming^*

来源：Gastric Cancer, 2021, 24(1): 245-257.

DOI：10.1007/s10120-020-01110-3

• Pooled analysis
• Gastric cancer
• Laparoscopic total gastrectomy
• No
• 10 station
• Spleen-preserving splenic hilar lymphadenectomy

Background For patients with locally advanced proximal gastric cancer (LAPGC), the individualized selection of patients with highly suspected splenic hilar (No. 10) lymph node (LN) metastasis to undergo splenic hilar lymphadenectomy, is a clinical dilemma. This study aimed to re-evaluate the feasibility and safety of laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) and to identify the population who would benefit from it. Methods A total of 1068 patients (D2 group = 409; D2 + No. 10 group = 659) who underwent laparoscopic total gastrectomy from four prospective trials between January 2015 and July 2019 were analyzed. Results No significant difference in the incidence (16.9% vs. 16.4%;P = 0.837) of postoperative complications were found between the two groups. The metastasis rate of No. 10 LN among patients in the D2 + No. 10 group was 10.3% (68/659). Based on the decision tree, patients with LAPGC with tumor invading the greater curvature (Gre), patients with non-Gre-invading LAPGC with a tumor size > 5 cm and clinical positive locoregional LNs were defined as the high-priority No. 10 dissection group. The metastasis rate of No. 10 LNs in the high-priority group was 19.4% (41/211). In high-priority group, the 3-year overall survival of the D2 + No. 10 group was better than that of the D2 group (74.4% vs. 42.1%;P = 0.005), and the therapeutic index of No. 10 was higher than the indices of most suprapancreatic stations. Conclusions LSPSHL for LAPGC is safe and feasible when performed by experienced surgeons. LSPSHL could be recommended for the high-priority group patients even without invasion of the Gre.

• 单位
  广东省人民医院; 复旦大学; 上海交通大学; 广州中医药大学; 厦门大学; 1; 北京大学; 南方医科大学; 四川大学; 西安交通大学