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Long-Term Natural Course of Patients with Lymph Node Station 6 Metastasis after Pylorus-Preserving Gastrectomy

Authors
Sa-Hong Kim1, Franco José Signorini2, Jeesun Kim1, Yo-Seok Cho1, Seong-Ho Kong1,3,4, Do-Joong Park1,3,4, Hyuk-Joon Lee1,3,4, Han-Kwang Yang1,3,4

Affiliations

  1. Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
  2. Private University Hospital of Córdoba, Córdoba, Argentina
  3. Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
  4. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

Introduction
We aimed to demonstrate the oncological safety of lymph node 6 station (LN#6) metastasis after pylorus-preserving gastrectomy (PPG) in terms of incidence, and 5-year survival rate (5YSR) and recurrence-free survival rate (RFS). Additionally, we investigate the pattern of LN#6 metastasis based on cross-sectional tumor location to customize the surgical burden on LN#6 dissection.

Methods
We reviewed electronic medical records of PPG patients at Seoul National University Hospital (2007-2017) to compare the incidence, and 5YSR and RFS of each LN station metastasis. The therapeutic indices (TI) of LN#6 for gastric middle-third tumors, including low body (LB) and midbody (MB), were calculated according to cross-sectional locations, including lesser curvature (LC), anterior wall (AW), greater curvature (GC), and posterior wall (PW).

Results
In a cohort of 1,070 PPG patients, LN#6 metastasis was observed in eleven patients (1.03%), of which three patients experienced recurrence (0.28%). LN#6 metastasis significantly affected RFS (p=0.033) but not 5YSR (p=0.134). Among the eleven patients with LN#6 metastasis, LB GC was the most prevalent tumor location (5/11, 45.45%). TI of LN#6 for LB GC and MB GC tumors was 3.76 and 0.0, while TI for both LB LC and MB LC was 0.0.

Conclusion
The incidence of LN#6 metastasis is rare, and patients with LN#6 metastasis showed a favorable 5YSR. Given the notably low therapeutic indices of LN#6 in LC tumors, it is feasible to reduce the surgical burden of excessive LN#6 dissection during PPG for patients with LC tumors.