Prime suspect or collective responsibility: Impact of specific lymph node station dissection on short- and long-term outcomes among locally advanced gastric cancer patients after neoadjuvant chemotherapy

Katarzyna Sędłak; Marcin Kubiak; Zuzanna Pelc; Radosław Mlak; Sebastian Kobiałka; Magdalena Leśniewska; Katarzyna Mielniczek; Katarzyna Chawrylak; Andrew Gumbs; S Vincent Grasso; Timothy M Pawlik; Wojciech P Polkowski; Karol Rawicz-Pruszyński

doi:10.1016/j.ejso.2024.109545

Prime suspect or collective responsibility: Impact of specific lymph node station dissection on short- and long-term outcomes among locally advanced gastric cancer patients after neoadjuvant chemotherapy

Eur J Surg Oncol. 2024 Dec 12;51(3):109545. doi: 10.1016/j.ejso.2024.109545. Online ahead of print.

Affiliations

¹ Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland. Electronic address: katarzyna.sedlak@umlub.pl.
² Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland.
³ Department of Laboratory Diagnostics, Medical University of Lublin, Chodźki 1 St., 20-093, Lublin, Poland.
⁴ Department of General-, Visceral-, Vascular- and Transplantation Surgery, University of Magdeburg, Magdeburg, Germany; Department of Advanced & Minimally Invasive Surgery, American Hospital of Tbilisi, Tbilisi, Georgia.
⁵ Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA.
⁶ Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.

PMID: 39675307
DOI: 10.1016/j.ejso.2024.109545

Abstract

Background: Lymphatic route is the main pathway for gastric cancer (GC) spread, and lymph node (LN) involvement is a major prognostic factor after curative resection. The aim of this study was to assess the outcomes of specific LN station dissection.

Methods: Patients with locally advanced (cT2-4N0-3M0) GC who underwent multimodal treatment between 2013 and 2023 were included in the study. Patients who had not undergone gastrectomy, had early (cT1) or metastatic GC, who had undergone multiorgan resections, palliative care, had died before the end of curative-intent planned treatment, or had incomplete clinical or pathological information were excluded. The primary endpoint was the development of serious complications, and the secondary outcome was OS.

Results: Mulivariable analysis revealed, that among patients who received neoadjuvant chemotherapy (NAC), it was observed that station 10 lymphadenectomy was associated with a higher risk of serious postoperative complications. (27.6 % vs 8.7 %; OR = 3.28) Among the no-NAC group, it was observed that station 13 lymphadenectomy was associated with a higher risk of serious postoperative complications. (57.1 % vs 13.2 %; OR = 6.96). Among the NAC group, a lower risk of death was observed in patients with station 8 (HR = 0.53) or 11 lymphadenectomy (HR = 0.53).

Conclusion: While D2 lymphadenectomy remains crucial, particularly in in high-volume, experienced GC centers, the necessity of a more extensive D2+ lymphadenectomy is not supported by our findings. Moreover, we aimed to highlight the importance of tailored surgical approaches and emphasize the significance of LN station dissection in influencing both short-term complications and long-term survival outcomes.