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Surg Endosc. 2018 Mar;32(3):1495-1505. doi: 10.1007/s00464-017-5837-x. Epub 2017 Sep 15.

Safety and prognostic impact of prophylactic laparoscopic superior mesenteric vein (No. 14v) lymph node dissection for lower-third gastric cancer: a propensity score-matched case-control study.

Chen QY1,2,3,4, Zheng CH1,2,3,4, Li P1,2,3,4, Xie JW1,2,3,4, Wang JB1,2,3,4, Lin JX1,2,3,4, Lu J1,2,3,4, Cao LL1,2,3,4, Lin M1,2,3,4, Tu RH1,2,3,4, Huang ZN1,2,3,4, Lin JL1,2,3,4, Huang CM5,6,7,8.

Author information

1
Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
2
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
3
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
4
Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
5
Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China. hcmlr2002@163.com.
6
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. hcmlr2002@163.com.
7
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. hcmlr2002@163.com.
8
Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China. hcmlr2002@163.com.

Abstract

AIM:

To investigate oncologic efficacy of prophylactic laparoscopic superior mesenteric vein (No. 14v) lymph node (LN) dissection for lower-third gastric cancer (LTGC).

METHODS:

We retrospectively collected data from 757 patients who underwent laparoscopic-assisted distal gastrectomy for LTGC. Of these patients, 102 underwent 14v LN dissection (14vD+ group), and the remaining 655 patients did not undergo 14v LN dissection (14vD- group). The outcomes were compared using a 1:1 propensity score matching method.

RESULTS:

After matching, 93 patients from the 14vD+ group and 93 patients from the 14vD- group with similar clinicopathological characteristics were compared. Before matching, the overall survival (OS) was similar between the two groups (P = 0.742). After matching, the OS was greater in the 14vD+ group (P = 0.025). The status of 14v dissection was not a significant prognostic factor in the survival analyses, both before and after matching. However, a stratified analysis according to the independent factors in the OS showed that the OS in the 14vD+ group was higher than that in the 14vD- group for cT2-3 patients after matching. The forest plot of OS showed that after matching the 14vD+ group had a significantly higher 3-year OS rate than the 14vD- group in cT2-3 patients. The distribution of the therapeutic index demonstrated that the index of 14v LN was similar to those of Nos. 1, 7, 8a, 9, and 11p after matching.

CONCLUSIONS:

Adding laparoscopic 14v dissection for laparoscopic-assisted radical distal gastrectomy was safe and might improve the OS for clinically advanced LTGC without serosal invasion.

KEYWORDS:

Gastric carcinoma; Lymphadenectomy; No. 14v lymph node; Prognosis; Propensity score matching

PMID:
28916893
DOI:
10.1007/s00464-017-5837-x

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