10 This study was not powered to find a difference in posterior patients ( n = 66), and thus positing that there is a real benefit to No. 10 LND in these posterior tumors would be premature as well. 10 LND in neoadjuvant patients was not observed. These authors previously examined this population in their propensity-matched study, but this group was only 23 patients and a survival difference for No. While the omission of these patients is in line with Asian standards and affords some intellectual purity to this study, applying these findings to a patient treated with neoadjuvant chemotherapy would be a mistake. By clinical T stage alone, all of these patients would have been given neoadjuvant chemotherapy according to NCCN guidelines. Furthermore, the application of these data to Western populations is limited, given the exclusion of patients who received neoadjuvant chemotherapy. That said, it should be clear that this is a negative study that did not find a survival benefit to spleen-preserving No. 10 LND and D2 lymphadenectomy, over D2 lymphadenectomy alone, in patients undergoing laparoscopic total gastrectomy for advanced proximal gastric cancer not involving the greater curvature. There are valid criticisms of this trial, although first and foremost the authors should be saluted for performing a well-designed surgical randomized trial-it is a testament to what is possible in this disease at high-volume centers with experienced surgeons. 10 nodes was 17.6% versus 12.7% in the non-posterior group. In the subgroup analysis, in the posterior group, the percentage of positive No. 10 nodes were positive and varied by T stage (4.9% T1 → 22.9% T4a). 38), the difference of which was accounted for by the No. As expected, the number of lymph nodes dissected was higher in the No. 10 LND group compared with the D2-alone group (44 vs. However, it should be noted that this subgroup analysis was comprised of only 66 patients. 10 LND versus a D2 alone, an effect that was also present after multivariate analysis and was particularly pronounced in >T2 tumors (DFS 92.9% vs. Intriguingly, stratification by tumor location found that posterior tumors had substantially better DFS and OS when undergoing a No. The groups were even in their receipt of adjuvant systemic chemotherapy. 10 LND added a median of 13 min to the operative time. 10 LND group required a splenectomy, and none in the D2 group. The overall morbidity rates in this paper were strikingly low, 16.9% overall, and were even between groups. 66.5% p = 0.02), this effect washed out on multivariate analysis. While there was a difference in 3-year OS (75.7% vs. There was no difference in 3-year DFS between the groups (70.3% in No. 10 LND and 64.3% in D2 p = 0.11). The groups were evenly matched, with 74.5% of males and a mean age of 60.6 years. 6, 7 These nodes are positive in a wide range of cases, anywhere from 9.8 to 27.9%. 5 However, as the surgical techniques for gastrectomy and lymph node dissection (LND) have improved, including with minimally invasive techniques, further attempts have been made to assess both the necessity and benefit of a spleen-preserving No. 10 nodes were removed from the definition of D2 lymphadenectomy in the most recent Japanese guidelines.
#HILAR LYMPH NODES TRIAL#
This subset of tumors was studied in a randomized controlled trial in Japan (JCOG0110), which found no survival benefit to splenectomy in this population with increased morbidity and mortality. While a bulky greater curvature tumor invading the spleen, or close to it, will often necessitate a splenectomy, it has been unclear what to do in other tumors that may be at risk, so called ‘proximal tumors without greater curvature involvement’. This was, in part, because a splenectomy was thought to be necessary for complete removal of this basin. 10) nodes, have historically been part of the D2 lymphadenectomy but their inclusion in routine gastrectomy for advanced proximal gastric cancers has been questioned. The splenic hilar lymph nodes, also known as the number 10 (No.
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