Journal of Gastric Cancer

  • 제21권2호
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  • Pages.169-178
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  • 2021
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
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Oncologic Feasibility of Proximal Gastrectomy in Upper Third Advanced Gastric and Esophagogastric Junctional Cancer

  • Yun, Won-Gun (Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lim, Myung-Hoon (Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Sarah (Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Sa-Hong (Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Park, Ji-Hyeon (Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kong, Seong-Ho (Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Park, Do Joong (Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, Hyuk-Joon (Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Yang, Han-Kwang (Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine)
  • 투고 : 2021.05.10
  • 심사 : 2021.06.08
  • 발행 : 2021.06.30
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초록

Purpose: The aim of this study was to investigate the oncologic safety and identify potential candidates for proximal gastrectomy (PG) in upper third advanced gastric cancer (AGC) and esophagogastric junction (EGJ) cancers. Materials and Methods: Among 5,665 patients who underwent gastrectomy for gastric adenocarcinoma between January 2011 and December 2017, 327 patients who underwent total gastrectomy with standard lymph node (LN) dissection for upper third AGC and Siewert type II EGJ cancers were enrolled. We analyzed the correlation between the metastatic rates of distal LNs (No. 4d, 5, 6, and 12a) around the lower part of the stomach and the clinicopathological characteristics. We identified subgroups with no metastasis to the distal LNs. Results: The metastatic rate of distal LNs in proximal AGC and Siewert type II EGJ cancers was 7.0% (23 of 327 patients). On multivariate analysis, pathological T stage (P=0.001), tumor size (P=0.043), and middle third invasion (P=0.003) were significantly associated with distal LN metastases. Pathological 'T2 stage' (n=88), or 'T3 stage with ≤5 cm tumor size' (n=87) showed no metastasis in distal LNs, regardless of middle third invasion. Pathological T3 stage with tumor size > 5 cm (n=61) and T4 stage (n=91) had metastasis in the distal LNs. Conclusions: In the upper third AGC and Siewert type II EGJ cancer, pathological T2 and small-sized T3 stage groups are possible candidates for PG in cases without distal LN metastasis. Further validation studies are required for clinical application.

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참고문헌

  1. Tan MC, Balakrishnan M, Graham DY. Gastric cancer worldwide except Japan. In: Shiotani A, ed. Gastric Cancer. Singapore: Springer, 2019:17-28.
  2. Ko KP. Epidemiology of gastric cancer in Korea. J Korean Med Assoc 2019;62:398-406. https://doi.org/10.5124/jkma.2019.62.8.398
  3. Eom BW, Jung KW, Won YJ, Yang H, Kim YW. Trends in gastric cancer incidence according to the clinicopathological characteristics in Korea, 1999-2014. Cancer Res Treat 2018;50:1343-1350. https://doi.org/10.4143/crt.2017.464
  4. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021;24:1-21. https://doi.org/10.1007/s10120-020-01042-y
  5. Park DJ, Park YS, Ahn SH, Kim HH. Laparoscopic proximal gastrectomy as a surgical treatment for upper third early gastric cancer. Korean J Gastroenterol 2017;70:134-140. https://doi.org/10.4166/kjg.2017.70.3.134
  6. Jung DH, Lee Y, Kim DW, Park YS, Ahn SH, Park DJ, et al. Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer. Surg Endosc 2017;31:3961-3969. https://doi.org/10.1007/s00464-017-5429-9
  7. Cho M, Son T, Kim HI, Noh SH, Choi S, Seo WJ, et al. Similar hematologic and nutritional outcomes after proximal gastrectomy with double-tract reconstruction in comparison to total gastrectomy for early upper gastric cancer. Surg Endosc 2019;33:1757-1768. https://doi.org/10.1007/s00464-018-6448-x
  8. Nakamura M, Yamaue H. Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach: a review of the literature published from 2000 to 2014. Surg Today 2016;46:517-527. https://doi.org/10.1007/s00595-015-1185-4
  9. Ahn SH, Lee JH, Park DJ, Kim HH. Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer. Gastric Cancer 2013;16:282-289. https://doi.org/10.1007/s10120-012-0178-x
  10. Seo HS, Lee GE, Kang MG, Han KH, Jung ES, Song KY. Mixed histology is a risk factor for lymph node metastasis in early gastric cancer. J Surg Res 2019;236:271-277. https://doi.org/10.1016/j.jss.2018.11.055
  11. Kim SM, Lee H, Min BH, Kim JJ, An JY, Choi MG, et al. A prediction model for lymph node metastasis in early-stage gastric cancer: toward tailored lymphadenectomy. J Surg Oncol 2019;120:670-675. https://doi.org/10.1002/jso.25628
  12. Jin EH, Lee DH, Jung SA, Shim KN, Seo JY, Kim N, et al. Clinicopathologic factors and molecular markers related to lymph node metastasis in early gastric cancer. World J Gastroenterol 2015;21:571-577. https://doi.org/10.3748/wjg.v21.i2.571
  13. Oh SY, Lee KG, Suh YS, Kim MA, Kong SH, Lee HJ, et al. Lymph node metastasis in mucosal gastric cancer: reappraisal of expanded indication of endoscopic submucosal dissection. Ann Surg 2017;265:137-142. https://doi.org/10.1097/SLA.0000000000001649
  14. Akagi T, Shiraishi N, Kitano S. Lymph node metastasis of gastric cancer. Cancers (Basel) 2011;3:2141-2159. https://doi.org/10.3390/cancers3022141
  15. Kumamoto T, Kurahashi Y, Niwa H, Nakanishi Y, Okumura K, Ozawa R, et al. True esophagogastric junction adenocarcinoma: background of its definition and current surgical trends. Surg Today 2020;50:809-814. https://doi.org/10.1007/s00595-019-01843-4
  16. Suh YS, Lee KG, Oh SY, Kong SH, Lee HJ, Kim WH, et al. Recurrence pattern and lymph node metastasis of adenocarcinoma at the esophagogastric junction. Ann Surg Oncol 2017;24:3631-3639. https://doi.org/10.1245/s10434-017-6011-3
  17. Siewert JR, Stein HJ. Carcinoma of the gastroesophageal junction - classification, pathology and extent of resection. Dis Esophagus 1996;9:173-182.
  18. Ahn SH, Jung DH, Son SY, Lee CM, Park DJ, Kim HH. Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer 2014;17:562-570. https://doi.org/10.1007/s10120-013-0303-5
  19. Jung DH, Ahn SH, Park DJ, Kim HH. Proximal gastrectomy for gastric cancer. J Gastric Cancer 2015;15:77-86. https://doi.org/10.5230/jgc.2015.15.2.77
  20. Rosa F, Quero G, Fiorillo C, Bissolati M, Cipollari C, Rausei S, et al. Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach: a propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer-GIRCG). Gastric Cancer 2018;21:845-852. https://doi.org/10.1007/s10120-018-0804-3
  21. Sugoor P, Shah S, Dusane R, Desouza A, Goel M, Shrikhande SV. Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary. Langenbecks Arch Surg 2016;401:687-697. https://doi.org/10.1007/s00423-016-1422-3
  22. Yura M, Yoshikawa T, Otsuki S, Yamagata Y, Morita S, Katai H, et al. Oncological safety of proximal gastrectomy for T2/T3 proximal gastric cancer. Gastric Cancer 2019;22:1029-1035. https://doi.org/10.1007/s10120-019-00938-8
  23. Nomura E, Lee SW, Tokuhara T, Nitta T, Kawai M, Uchiyama K. Functional outcomes according to the size of the gastric remnant and the type of reconstruction following distal gastrectomy for gastric cancer: an investigation including total gastrectomy. Jpn J Clin Oncol 2013;43:1195-1202. https://doi.org/10.1093/jjco/hyt141
  24. Kurokawa Y, Takeuchi H, Doki Y, Mine S, Terashima M, Yasuda T, et al. Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann Surg 2019;274:120-127.
  25. Papanikolaou IS, Triantafyllou M, Triantafyllou K, Rosch T. EUS in the management of gastric cancer. Ann Gastroenterol 2011;24:9-15.
  26. Yu T, Wang X, Zhao Z, Liu F, Liu X, Zhao Y, et al. Prediction of T stage in gastric carcinoma by enhanced CT and oral contrast-enhanced ultrasonography. World J Surg Oncol 2015;13:184. https://doi.org/10.1186/s12957-015-0577-7
  27. Sato Y, Katai H, Ito M, Yura M, Otsuki S, Yamagata Y, et al. Can proximal gastrectomy be justified for advanced adenocarcinoma of the esophagogastric junction? J Gastric Cancer 2018;18:339-347. https://doi.org/10.5230/jgc.2018.18.e33