| Objective:The aim of present study was to elucidate the necessity of No.14v lymph node dissection in lymphadenectomy for gastric cancer (GC).Methods:A total of988GC patients who underwent gastrectomy with D2or more than D1+lymphadenectomy between January2003and March2011in our center were enrolled in this study, of whom,311patients also underwent dissection of the lymph node along the superior mesenteric vein (No.14v). Other677patients with tumors located at lower or middle third of the stomach but without No.14v lymph node removed were used for comparision. Clinical pathological factors associated with metastasis to No.14v lymph node were analysized. Also prognostic impact of metastasis to or dissection of No.14v lymph node was evaluated.Results:1. Of the311GC with No.14v dissection,50(16.1%) cases had positive No.14v lymph node. Tumors located in the lower or middle third of the stomach, which invaded the serosa or adjacent stuctures, had higher incidence of metastasis to No.14v lymph node, which can reach20.9%. Factors associated with No.14v metastasis including tumor location, Borrmann type, depth of invasion, N stage, distant metasis, No.1,3,4sb,4d,5,6,7,8a,9, l1p and12a lymph node metastasis. In multivariate analysis, only No.4d (RR:3.782,95%CI:1.181-12.112, p=0.025), No.6lymph node metastasis (RR:4.352,95%CI:1.331-14.062, p=0.015) and distant metatasis (RR:5.756,95%CI:1.308-25.326, p=0.021) were independent risk facors for metastasis to No.14v lymph node.2. All GC patients with No.14v lymph node dissection were devided into2groups according No.14v status:14v positive group (14v+) and14v negative group (14v-). The3-year overall survival (OS) were34.0%and67.0%for patients with and without14v metastasis, respectively. The difference was significant. Following TNM stratified analysis, for patients staged â…¢, those with14v metastasis still had a significant lower OS than those without (3-year OS:42.9%vs57.6%, p=0.005). In multivariate analysis, metastasis to No.14v was not an independent prognostic factor for GC patients with14v dissection, while it was an independent prognostic factor for stage â…¢ patients in subgroup analysis (HR=1.694,95%CI:1.071-2.680, p=0.024). Patients with14v metastasis had a poor prognosis. Tumor size, TNM stage and distant metastasis were significant prognostic factors for14v positive patients.3. Patients with tumors located at lower or middle third of the stomach were grouped according to No.14v lymphadenectomy (14vD+/14vD-). The3-year OS were63.4%and53.9%for14vD+and14vD-group respectively, the difference was not significant. In stages â… , â…¡, â…¢a, and â…£, No.14v lymph node dissection did not affect overall survival, in contrast,14v lymph node dissection was an independent prognostic factor in patients with TNM stage â…¢b/â…¢c GC (HR=0.670,95%CI:0.506-0.886, p=0.005)Conclusion:For tumors located in lower or middle of the stomach, those with serosa invasion have a high incidence of No.14v lymph node metastasis. Metastasis to14v was an independent prognostic factor for â…¢ stage GC patients. Standard gastrectomy including No.14v lymph node dissection seems to be associated with improved OS of patients with TNM stage â…¢b/â…¢c GC in the middle or lower third of the stomach, for such patients without distant metastasis, especially those with possibility of No.14d,6lymph node metastasis, No.14v lymph node is suggested to be removed. |
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