A three-step method for modular lymphadenectomy in gastric cancer surgery: The ability to retrieve sufficient lymph nodes and improve survival - 08/12/17

Doi : 10.1016/j.amjsurg.2017.01.042

Maolan Li ^a,^b,^{^{1
These authors contributed equally to this work.}}, Xu-an Wang ^a,^b,^{^{1
These authors contributed equally to this work.}}, Lei Wang ^c,^{^{1
These authors contributed equally to this work.}}, Xiangsong Wu ^a,^b, Wenguang Wu ^a,^b, Xiaoling Song ^a,^b, Shuai Zhao ^a,^b, Fei Zhang ^a,^b, Qiang Ma ^a,^b, Haibin Liang ^a,^b, Shanshan Xiang ^a,^b, Zheng Wang ^a,^b, Wei Gong ^a,^b,^⁎,^{^{2
These authors jointly directed this work.}} , Ping Dong ^a,^b,^⁎,^{^{2
These authors jointly directed this work.}} , Yingbin Liu ^a,^b,^⁎,^{^{2
These authors jointly directed this work.}}
^a Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
^b Shanghai Research Center of Biliary Tract Disease, Shanghai, China
^c Department of Hepatobiliary Surgery, Nanjing Medical University Affiliated Wuxi No2 Hospital, Jiangsu, China

^∗Corresponding author. Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.Department of General SurgeryXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai200092China^∗∗Corresponding author. Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.Department of General SurgeryXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai200092China^∗∗∗Corresponding author. Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.Department of General SurgeryXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai200092China

Abstract

Background

Systematic lymphadenectomy for the resection of sufficient lymph nodes is the most important part of curative resection in gastric cancer surgery. Here, we explore the outcomes of the three-step method for modular lymphadenectomy (TSMML) and determine its safety and efficacy, compared with the conventional method for lymphadenectomy (CML).

Methods

From 2008 to 2011, 270 patients with gastric cancer were divided into 2 subgroups: the TSMML group and the CML group.

Results

Patients in the TSMML group had a significantly higher median number of retrieved lymph nodes (rLNs), lower median metastatic lymph node ratios (MLRs), and superior 5-year relapse-free survival (RFS) than the CML group. Moreover, the use of the TSMML procedure was an independent protective factor for RFS. No significant intergroup differences were found in morbidity or mortality in these two groups.

Conclusion

The TSMML procedure is safe and effective and is easy to learn.

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Highlights

•	This study assessed the outcomes of the three-step method for modular lymphadenectomy (TSMML) and the conventional method for lymphadenectomy (CML) in gastric cancer patients.
•	Compared to the conventional method, the TSMML procedure can achieve sufficient retrieved lymph nodes (rLNs), lower metastatic lymph node ratios (MLRs) and higher 5-year relapse-free survival (RFS).
•	The SMML procedure is safe, effective, and easy to learn.

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Keywords : Gastric cancer, Lymphadenectomy, Retrieved lymph nodes, Survival

Plan

Introduction

Patients and methods

Surgical procedures

Postoperative management

Patient follow-up

Statistical analysis

Results

Patient clinicopathologic characteristics

Short-term surgical outcomes

Long-term survival

Discussion

Conclusion

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Vol 215 - N° 1

P. 91-96 - janvier 2018 Retour au numéro

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A three-step method for modular lymphadenectomy in gastric cancer surgery: The ability to retrieve sufficient lymph nodes and improve survival - 08/12/17

Abstract

Background

Methods

Results

Conclusion

Highlights

Plan

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