Upper lesser curvature skeletonization in radical distal gastrectomy

Area of Science:

• Surgical Oncology
• Gastroenterology
• Pathology

Background:

• Investigating metastatic status of lymph nodes (1, 3a, 3b) in radical distal gastrectomy.
• Identifying risk factors for lesser curvature regional node (LCRN) metastasis.

Purpose of the Study:

• To assess the metastatic status of specific lymph node groups (1, 3a, 3b) during radical distal gastrectomy.
• To determine risk factors associated with LCRN metastasis.

Main Methods:

• Retrospective analysis of 112 patients undergoing radical distal gastrectomy (May 2010-September 2013).
• Comparison of clinicopathologic features between LCRN-positive and LCRN-negative groups.
• Univariate and multivariate analyses to identify independent risk factors for LCRN metastasis.

Main Results:

• 45.5% of patients had metastatic LCRNs; 59.8% were node-positive overall.
• Significant differences in features (gender, tumor size, grade, Lauren classification, gross type, T, N, TNM stages) between LCRN+ and LCRN- groups.
• Stage T3-4 and positive no. 4d nodes identified as independent risk factors for LCRN metastasis.

Conclusions:

• LCRNs exhibit high metastasis rates in lower gastric cancers and function as an entity within the lesser curvature.
• Upper lesser curvature skeletonization is recommended for radical distal gastrectomy, particularly for T3-4 stages or suspicious no. 4d nodes.