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Impact of skip metastasis in gastric cancer
Sung-Soo Park1, Je-Seock Ryu, Byung-Wook Min
1Department of Surgery, Korea University College of Medicine, Seoul, Korea.
Background:
Several studies have shown the features of skip metastasis in other cancers besides gastric cancer. Since minimally invasive surgery has been applied to gastric cancer, the concerns and awareness of skip metastasis have grown in the medical community. We conducted the present retrospective study to reveal the clinicopathological characteristics of patients with skip metastasis. We also wished to clarify the clinical impact of skip metastasis for gastric cancer.
Methods:
Five hundred and eighty-nine patients having lymphatic metastases were enrolled in the present study. Among them, 266 patients had positive nodes extending into the N2 group. We divided these patients into the skip positive (+) and the skip negative (-) group, and we comparatively analysed clinicopathological factors and calculated the survival probabilities for the two groups.
Results:
The skip (+) and skip (-) groups involved 14 (5.3%) and 252 (94.7%) patients, respectively. Of all the investigated factors, a significant difference between two groups was observed only in the total number of retrieved nodes. Stations of skip nodes were along left gastric (7), anterior common hepatic (8a), celiac (9), splenic (11) artery and right paracardial nodes (1). The survival curves calculated in the present study did not show any statistical differences between the groups.
Conclusions:
Due to problems of skip metastasis in gastric cancer, D2 lymph node dissection should be performed until sentinel node detection is feasible and reliable. The potential risk from skip metastasis is not great and skip metastasis itself should not be a major consideration in therapeutic decisions.
Insights
Skip metastasis in gastric cancer is uncommon and does not significantly impact survival. D2 lymph node dissection is recommended until sentinel node detection is reliable.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Skip metastasis, a pattern of lymphatic spread, is increasingly recognized in gastric cancer.
- Minimally invasive surgery for gastric cancer has heightened awareness of skip metastasis.
- This study investigates the characteristics and clinical impact of skip metastasis in gastric cancer patients.
Purpose of the Study:
- To identify clinicopathological features associated with skip metastasis in gastric cancer.
- To evaluate the clinical significance and prognostic impact of skip metastasis.
Main Methods:
- Retrospective analysis of 589 gastric cancer patients with lymphatic metastases.
- Comparison of clinicopathological factors and survival between skip metastasis-positive (N2 involvement) and skip metastasis-negative groups.
- Analysis included 266 patients with positive N2 nodes.
Main Results:
- Skip metastasis was identified in 5.3% (14 patients) of the study cohort.
- The total number of retrieved nodes was the only significant difference between skip-positive and skip-negative groups.
- Skip nodes were located in specific lymphatic stations (e.g., left gastric, common hepatic artery, celiac axis).
- No statistically significant difference in survival curves was observed between the groups.
Conclusions:
- Skip metastasis in gastric cancer appears to have a limited clinical impact.
- D2 lymph node dissection is advised for gastric cancer management until sentinel node biopsy is a reliable alternative.
- Skip metastasis should not be a primary factor in treatment decisions.
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