Outcomes of Laparoscopic Total Gastrectomy Combined With Spleen-Preserving Hilar Lymphadenectomy for Locally Advanced Proximal Gastric Cancer A Nonrandomized Clinical Trial
机构：[1]Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.[2]Fujian Medicine University, Teaching Hospital, The First Hospital of PuTian City, Putian, China.[3]Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.[4]Department of General Surgery Unit 4, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.[5]Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.[6]Department of General Surgery, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China.江苏省人民医院[7]Department of Gastrointestinal Surgery, Affiliated Hospital of Qinghai University, Qinghai Medical University, Xining, China.[8]Department of General Surgery Unit 2, Meizhou People's Hospital of Guangdong, Meizhou, China.[9]Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Fuzhou, China.[10]Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.[11]Department of General Surgery, Longyan First Hospital, Longyan, China.[12]Department of General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Wulumuqi, China.[13]Department of General Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China.广东省中医院[14]Department of General Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.[15]Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Sichuan University, Chengdu, China.四川大学华西医院[16]Gastrointestinal Cancer Center, Beijing University Cancer Hospital, Beijing, China.[17]Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China.[18]Department of General Surgery, Guangdong Provincial People's Hospital, Guangzhou, China.广东省人民医院[19]Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
The long-term survival of patients with laparoscopic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy (LSTG) for advanced upper-third gastric cancer (AUTGC) and the association of splenic hilar lymph node (LN-10) metastasis with survival remain controversial.To evaluate the long-term outcomes of LSTG and the value index of LN-10 metastasis for patients with AUTGC.The Chinese Laparoscopic Gastrointestinal Surgery Study 4 (CLASS-04) was a prospective, multicenter, single-arm trial that involved 19 centers in China. A total of 251 eligible patients with clinical stage T2, T3, or T4a upper-third gastric cancer without distant metastases were enrolled from September 1, 2016, to October 31, 2017. The final follow-up was on December 31, 2020.All patients were enrolled to undergo LSTG.The main outcomes were the 3-year overall survival (OS) and disease-free survival (DFS). Multivariate analyses were used to explore the association of LN-10 metastasis with survival.Among the 251 patients, 246 (98.0%; mean [SD] age, 60.1 [9.4] years; 197 [80.1%] male) underwent LSTG and completed the study. The 3-year OS was 79.1% (95% CI, 74.0%-84.2%), and the 3-year DFS was 73.1% (95% CI, 67.4%-78.8%). In addition, the 3-year therapeutic value index of LN-10 dissection was 4.5, exceeding the indexes for the partial D2 LN group (including LNs 5, 6, 11d, and 12a). Nineteen patients (7.7%) with LN-10 metastasis had significantly worse survival than the nonmetastasis group, and multivariate analysis revealed that splenic LN-10 metastasis was an independent risk factor (OS: hazard ratio [HR], 2.38; 95% CI, 1.08-5.26; P = .03; DFS: HR, 2.28; 95% CI, 1.12-4.63; P = .02). Moreover, patients with LN-10 metastasis were more likely to have recurrence (42.1% vs 20.7%, P = .03), especially when multiple site metastasis was present (21.1% vs 4.4%, P = .01). However, patients with LN-10 metastasis who received adjuvant chemotherapy had significantly better OS and DFS than those without adjuvant chemotherapy and achieved the same oncologic effect as those without LN-10 metastasis.This results of this study suggest that LSTG for AUTGC has feasible long-term outcomes. In addition, patients with LN-10 metastasis may have worse survival and may be more prone to recurrence.
基金：
grant 2017Y9011 from Joint Funds for the Innovation of Science
and Technology, Fujian Province (Dr Zheng).
第一作者机构：[1]Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
共同第一作者：
通讯作者：
通讯机构：[1]Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.[*1]Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou 350001 Fujian Province, China.
推荐引用方式(GB/T 7714)：
Zheng Chaohui,Xu Yanchang,Zhao Gang,et al.Outcomes of Laparoscopic Total Gastrectomy Combined With Spleen-Preserving Hilar Lymphadenectomy for Locally Advanced Proximal Gastric Cancer A Nonrandomized Clinical Trial[J].JAMA NETWORK OPEN.2021,4(12):doi:10.1001/jamanetworkopen.2021.39992.
APA：
Zheng Chaohui,Xu Yanchang,Zhao Gang,Cai Lisheng,Li Guoxin...&Huang Changming.(2021).Outcomes of Laparoscopic Total Gastrectomy Combined With Spleen-Preserving Hilar Lymphadenectomy for Locally Advanced Proximal Gastric Cancer A Nonrandomized Clinical Trial.JAMA NETWORK OPEN,4,(12)
MLA：
Zheng Chaohui,et al."Outcomes of Laparoscopic Total Gastrectomy Combined With Spleen-Preserving Hilar Lymphadenectomy for Locally Advanced Proximal Gastric Cancer A Nonrandomized Clinical Trial".JAMA NETWORK OPEN 4..12(2021)
医学