Role of Hilar Splenic Lymphadenectomy in the Treatment of Gastric Cancer

Authors
Nguyen Viet Hai, Tran Quang Dat, Dang Quang Thong, Doan Thuy Nguyen, Vo Duy Long

Affiliations
Department of Gastro-Intestinal Surgery, University Medical Center, Ho Chi Minh City, Vietnam

Background
Splenic hilar lymphadenectomy has been traditionally included as part of D2 lymph node dissection following total gastrectomy for gastric cancer. However, recent studies suggested that station 10 lymph node (No.10 LN) dissection with or without splenectomy should be preserved for several situations. This study was conducted to determine the risk factors for No.10 LN metastasis and assessed the value of No.10 LN dissection by calculating the therapeutic index (TI).

Methods
A retrospective study on 92 patients who underwent radical total gastrectomy with D2 lymphadenectomy plus No.10 LN dissection for gastric adenocarcinoma in the University Medical Center at Ho Chi Minh City from Mars 2018 to December 2022. Clinicopathology features included tumor size, tumor location (longitudinal, crossectional), tumor staging (depth of invasion, pN status), Borrmann type, differentiation, lymphatic invasive status, and perineural invasive status. Primary outcomes were the incidence of No. 10 LN metastasís and 5-year survival.

Results
The mean number of harvested lymph nodes at station 10 was 2.5 ± 1.4. The incidence of No.10 LN metastasis was 22.8%. Univariate analysis demonstrated that factors associated with No.10 LN included tumor size, T4a staging, N3a/N3b staging, poor differentiation, Borrmann type 4, lymphatic invasion, greater curvature or posterior wall invasion, and positive No. 4sb/4d LN. The multivariate analysis showed that T4a staging, pN3 staging, greater curvature or posterior wall invasion, and Borrmann type 4 were independent risk factors for No.10 LN metastasis. The TI was also higher than 5 for cases with No. 4sa/4sb LN metastasis.

Conclusion
No.10 LN metastasis was associated with T4a staging, cN3 staging, greater curvature or posterior wall invasion, or Borrmann type 4 gastric adenocarcinoma. Besides, cases with macroscopic suspicious or intraoperative detected metastatic No. 4sa or 4sb LN should also be taken into account for No.10 LN dissection due to the high therapeutic index.