Five-year survival outcome of laparoscopic D2 lymphadenectomy plus complete mesogastrium excision for patients with stage II/III gastric cancer without invasion of the squamocolumnar junction

IF 2.7 2区医学 Q1 SURGERY Surgery Pub Date : 2025-03-10 DOI:10.1016/j.surg.2025.109290

Weixiang Chen MD , Zhiming Cai MD , Junpeng Li MD , Zhixiong Li MD , Zhengnan Xu MD , Jihuang Wu MD , Feng Liu MD , Hongrui Zhao MD , Yanchang Xu MD

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Abstract

Background

Gastric cancer patients without invasion of the squamocolumnar junction have a low probability of extragastric mesenteric metastasis, and the survival benefit of conducting D2 lymphadenectomy plus complete mesogastrium excision is unclear in this group of patients.

Methods

This was a retrospective analysis of patients with stage II/III gastric cancer without invasion of the squamocolumnar junction who underwent laparoscopic radical surgery for gastric cancer at the First Hospital of Putian City, Fujian Province, from January 2014 to May 2019. Five-year disease-free survival was the primary outcome, and 5-year overall survival and the recurrence pattern were the secondary outcomes. Morbidity, mortality, and surgery-related outcomes within 30 days of surgery were also analyzed.

Results

This study included 366 patients, 133 in the D2 lymphadenectomy group and 233 in the D2 lymphadenectomy plus complete mesogastrium excision group. There was no statistically significant difference in 5-year disease-free survival and overall survival in the D2 lymphadenectomy plus complete mesogastrium excision group compared with the D2 lymphadenectomy group (P > .05). Regarding recurrence pattern, the D2 lymphadenectomy group had a higher rate of local recurrence (12.3% and 38.3%, P = .001). In subgroup analysis, patients with stage III and T3-4aN1-3 gastric cancer in the D2 lymphadenectomy plus complete mesogastrium excision group had significantly better 5-year disease-free survival compared with the D2 lymphadenectomy group (P < .05).

Conclusion

Laparoscopic D2 lymphadenectomy plus complete mesogastrium excision not only decreased the local recurrence rate of stage II/III gastric cancer without invasion of the squamocolumnar junction, but it also improved the 5-year disease-free survival of patients with stage III and T3-4aN1-3 gastric cancer without invasion of the squamocolumnar junction.

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未侵犯鳞柱交界处的II/III期胃癌的腹腔镜D2淋巴结切除术加完全胃系膜切除术的5年生存率

背景：未侵犯鳞柱连接处的胃癌患者发生胃外肠系膜转移的概率较低，在这组患者中，行D2淋巴结切除术加全肠系膜切除术的生存获益尚不清楚。方法回顾性分析福建省莆田市第一医院2014年1月至2019年5月行腹腔镜胃癌根治术的未侵犯鳞柱交界处的II/III期胃癌患者。5年无病生存是主要结局，5年总生存和复发类型是次要结局。还分析了手术后30天内的发病率、死亡率和手术相关结果。结果本研究共纳入366例患者，其中D2淋巴结切除术组133例，D2淋巴结切除术加全肠系膜切除术组233例。D2淋巴结切除术加完全肠系膜切除术组与D2淋巴结切除术组相比，5年无病生存率和总生存率无统计学差异(P >；. 05)。在复发类型方面，D2淋巴结切除术组局部复发率更高（12.3%和38.3%,P = 0.001）。在亚组分析中，D2淋巴结切除术加完全胃系膜切除术组III期和T3-4aN1-3期胃癌患者的5年无病生存率明显优于D2淋巴结切除术组(P <；. 05)。结论腹腔镜D2淋巴结切除术加完全胃系膜切除术不仅降低了不侵犯鳞柱交界处的II/III期胃癌的局部复发率，而且提高了不侵犯鳞柱交界处的III期和T3-4aN1-3期胃癌患者的5年无病生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.