Key nodal stations for predicting splenic hilar nodal metastasis in upper advanced gastric cancer without invasion of the greater curvature

BACKGROUND: Standard surgery for upper advanced gastric cancer without invasion of the greater curvature (UGC‐GC) is spleen‐preserving D2 total gastrectomy without dissection of the splenic‐hilar nodes (#10).

However, some patients with nodal metastasis to #10 survive more than 5 years due to nodal dissection of #10.

If nodal metastasis to #10 is predictable based on the positivity of other nodes dissected by the current standard surgery without #10 nodal dissection, physicians may be able to consider #10 dissection.

METHODS: This study retrospectively reviewed data from the National Cancer Center Hospital in Japan between 2000 and 2012.

We selected cases that met the following criteria: (1) D2 or more total gastrectomy with splenectomy, (2) UGC‐GC, and (3) histological type is gastric adenocarcinoma.

We performed univariate and multivariate analyses concerning lymph node stations associated with #10 metastasis.

RESULTS: A total of 366 patients were examined.

A multivariate analysis revealed that #10 metastasis was associated with positivity of the nodes along the short gastric arteries (#4sa) and distal nodes along the splenic artery (#11d) (#4sa: p = 0.003, #11d: p = 0.016).

When either key node was positive, the metastatic rate of #10 was 24.4%, and the therapeutic value index was 13.3.

CONCLUSIONS: #4sa and #11d were key lymph nodes predicting #10 nodal metastasis in UGC‐GC.

When these key nodes are positive on computed tomography before surgery or according to a rapid pathological examination during surgery, dissection of #10 should be considered even if upper advanced tumors are not invading the greater curvature.