5 years ago

Left Gastric Artery Lymph Nodes Should Be Included in D1 Lymph Node Dissection in Gastric Cancer

Brian D. Badgwell, Paul F. Mansfield, Naruhiko Ikoma, Jaffer A. Ajani, Xuemei Wang, Jeannelyn S. Estrella, Mariela Blum, Keith F. Fournier



The Japanese Classification of Gastric Carcinoma includes the left gastric artery (#7) lymph nodes (LNs) in the recommended extent of D1 LN dissection, but this recommendation has not been validated in western institutions.


We reviewed data from a prospectively maintained database of gastric cancer patients who underwent resection at our academic cancer center and had a separate pathologic assessment of #7 LN in 2005–2016. Risk factors for #7 LN metastases and overall survival were examined by uni- and multivariable analyses.


We identified 173 patients; 114 (66%) were treated with preoperative therapy, most commonly with chemoradiation therapy (47%, 81/173). We identified 22 patients (13%) who had #7 LN metastases, which accounted for 35% (22/63) of node-positive patients. No preoperative factors were associated with #7 LN metastases by univariable analyses. Patients with #7 metastases were not associated with shorter overall survival after adjustment by nodal stage (hazard ratio 1.49, 95% confidence interval 0.67–3.32; p = 0.33).


Metastasis to #7 LN station was common in gastric cancer, but the survival impact was not significant after adjustment by nodal stage. We conclude that #7 LNs should be routinely dissected in gastric cancer patients, and this station should be included within the extent of D1 LN dissection.

Publisher URL: https://link.springer.com/article/10.1007/s11605-017-3539-2

DOI: 10.1007/s11605-017-3539-2

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