Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2015; 21(38): 10866-10873
Published online Oct 14, 2015. doi: 10.3748/wjg.v21.i38.10866
Clinical characteristics of hepatoduodenal lymph node metastasis in gastric cancer
Taisuke Imamura, Shuhei Komatsu, Daisuke Ichikawa, Toshiyuki Kosuga, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji
Taisuke Imamura, Shuhei Komatsu, Daisuke Ichikawa, Toshiyuki Kosuga, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Author contributions: Imamura T and Komatsu S contributed equally to this work; Imamura T, Komatsu S, Ichikawa D and Otsuji E designed the research; Imamura T, Kosuga T, Okamoto K and Shiozaki A performed the research; Imamura T, Konishi H and Fujiwara H analyzed the data; Imamura T and Komatsu S wrote the paper.
Institutional review board statement: This study was institutionally reviewed and comprehensively approved by the Kyoto Prefectural University of Medicine.
Informed consent statement: The patients provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: Technical appendix and study data are available from the corresponding author at skomatsu@koto.kpu-m.ac.jp (Shuhei Komatsu) under the permission of Shuhei Komatsu. Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shuhei Komatsu, MD, PhD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. skomatsu@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: March 29, 2015
Peer-review started: March 31, 2015
First decision: June 19, 2015
Revised: July 1, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: October 14, 2015
Processing time: 198 Days and 20.3 Hours
Abstract

AIM: To assess the clinical features of hepatoduodenal lymph node (HDLN) metastasis and to clarify the optimal indication of HDLN dissection.

METHODS: We investigated a total of 276 patients who underwent gastrectomy with extended lymphadenectomy, including HDLN dissection, for gastric cancer between 1999 and 2012. Of these, 26 patients (9.4%) had HDLN metastasis. First, we investigated the clinicopathological characteristics, their perioperative clinical outcomes, such as postoperative complications, and prognostic outcomes between patients with and without HDLN metastasis. Second, we detected the prognostic factors, particularly in patients with HDLN metastasis. Third, we assessed the therapeutic value of HDLN dissection to determine its optimal indication.

RESULTS: The five-year overall survival rate of the patients with HDLN metastasis was 29%. Univariate and multivariate logistic regression analyses revealed that the tumour location (the middle or lower stomach [P = 0.005, OR = 5.88 (95%CI: 1.61-38.1)] and pT category [T3 or T4, P = 0.017, OR = 4.45 (95%CI: 1.28-21.3)] were independent risk factors for HDLN metastasis. Cox proportional hazard analysis identified pN3 as an independent poor prognostic factor in the patients with HDLN metastasis [P = 0.021, HR = 5.17 (95%CI: 1.8-292)]. For patients who underwent radical HDLN dissection, HDLN metastasis was a prognostic indicator in pN3 gastric cancer (P < 0.0001), but not pN1-2 (P = 0.602). Furthermore, the index of therapeutic value of HDLN dissection for gastric cancer in the middle or lower stomach and the upper stomach was 3.4 and 0.0, respectively.

CONCLUSION: We suggest that HDLN dissection should be indicated for pN1 or pN2 gastric cancers located at the middle or lower stomach.

Keywords: Gastric cancer; Hepatoduodenal lymph node; D2 lymphadenectomy; Prognostic factor; Tumor location

Core tip: Gastric cancer located at the middle or lower stomach is a risk factor of hepatoduodenal lymph node (HDLN) metastasis and indicates relatively high therapeutic value of HDLN dissection. N-category, in especially pN3, is an independent poor prognostic factor in gastric cancer patients with HDLN metastasis. HDLN dissection should be indicated for N1 or N2 gastric cancers located at the middle or lower stomach.