The Risk Factors And Prognosis Analysis Of Lymph Node Skipping Metastasis In Gastric Cancer

Objective: With the increasing use of laparoscopic surgery in gastric cancer surgery,lymph node dissection is becoming more refined and standardized.However,due to the complexity of the lymphatic drainage system around the stomach,even early gastric cancer cannot accurately predict the metastasis of lymph nodes.The metastasis of lymph nodes further explains the variability of the lymphatic drainage system in the stomach.This makes a large part of patients with early gastric cancer undergo extensive lymphadenectomy,increasing trauma and surgical risk.In this study,the clinical data of gastric cancer patients with single lymph node metastasis were analyzed to explore the risk factors affecting the occurrence of lymph node skipping metastasis in gastric cancer and the risk factors that may affect its prognosis,providing clues for the fine range of lymph node dissection in clinical practice.Methods:Retrospective analysis of the clinical data of 128 patients with gastric cancer who were treated with D2 radical gastrectomy from Jan.2007 to Dec.2012 at the Department of Gastrointestinal Surgery,Fujian Provincial Cancer Hospital,and postoperative pathology confirmed a single lymph node metastasis.Twenty-nine patients with skipping metastasis were jump group and 99 patients without skip metastasis were control group.Statistical methods were used to compare the data of the two groups and the 5-year survival rate.Analysis the risk factors and prognosis of lymph node skipping metastasis in gastric cancer.Results: In the study,128 cases had a total of 3861 lymph node dissections,with an average of 30.1 pieces/case.There were 29 cases of jump metastases,accounting for 22.7%.Among these patients,there were 6,6,and 8 cases of skip metastasis in No.7,8 and 12 lymph nodes respectively.The incidence rates were 20.7%,20.7%,and 27.6% respectively,accounting for 69.0%,accounting for a high proportion.high.The univariate analysis of the factors related to lymph node skipping metastasis showed that there was no statistically significant difference in gender,age,tumor differentiation,presence or absence of lymphatic vessel thrombosis,nerve invasion,and surgical approach in the two groups;There was a statistically significant difference in tumor location(P=0.028),tumor size(P=0.027),and tumor invasion depth(P=0.026)between the groups.Jumping metastases of lymph nodes are more likely to occur in patients with a diameter less than 5 cm in the lower part and infiltrate more than the submucosa.The survival analysis showed that there was no significant difference in postoperative 5-year survival rate between the jumping group and the control group(55.2% vs 69.7%,P=0.148>0.05).Cox multivariate regression analysis showed that tumor infiltration depth was an independent risk factor for prognosis of patients with lymph node skipping metastasis.Conclusions:When gastric cancer has lymph node metastasis,the gastric circumference is No.7,8 and No.12 Lymph nodes are prone to jumping metastases.The location,diameter and infiltration depth of the tumor are the influencing factors for the occurrence of skip metastasis in gastric lymph nodes.The depth of tumor invasion is an independent risk factor for the prognosis of patients with gastric lymph node skipping metastases.For preoperative evaluation,it was found that patients with lower stomach cancer,diameter less than 5 cm,and more than T1 should routinely perform D2 + No.12 lymph node dissection,which can improve the 5-year survival rate of this group of patients.