Risk Factors For Metastasis To And Surgical Dissection Of No.8p And No.14v Lymph Nodes In Advanced Gastric Cancer: A Clinical Analysis

Objective: This study was to analyze the clinicopathologic characteristics of patients in the D2,D2+8p, and D2+14v groups, and to explore the clinical prognosis and safety with extended lymphadenectomy for lower third advanced gastric cancer. Further, the study mainly aimed at researching the clinicopathologic factors which influence the No.8p and No.14 v lymph nodes metastasis.Methods: From April 2008 to November 2015, 413 patients underwent curative resection for lower third advanced gastric cancer. They are grouped according to the scope of lymphadenectomy. There are three groups including the D2 group, D2+8p group and D2+14v group. Clinicopathologic characteristics and the prognosis were compared between the groups.The clinicopathologic factors which were related with the lymph node metastasis were evaluated using the Logistic analysis.Results: There were 107 patients who underwent D2+8p lymphadenectomy and the incidence of No.8p lymph nodes metastasis was 11.21%(12/107). There was no difference in operation time,hospital time and the rate of 3-year overall survival. A multivariate analysis showed the T stage(OR=3.474,95% CI=1.467~8.227,P=0.005), and the N stage(OR=2.888,95%CI=1.352~6.169,P=0.006) of tumors are associated with the No.8p lymph nodes metastasis and they were the independent influence factors.There were 102 patients who underwent D2+14v lymphadenectomy and the incidence of No.14 v lymph nodes metastasis was 23.53%(24/102). The operation time was longer in D2+14v group than that in D2 group(P<0.001). There was no difference in hospital time. The 3-year overall survival was higher in D2+14v group than that in D2 group(63.7% vs 52.5%, P=0.040).And the rate of 3-year overall survival were 33.3% and 73.1% for patients with and without No.14 v lymph nodes metastasis. The difference was significant(P<0.001). A multivariate analysis showed the T stage(OR=1.410,95%CI=1.119~3.833,P=0.040), histologic type(OR=11.232,95%CI=1.269~99.432,P=0.030), Lauren type(OR=2.139,95%CI=1.051~4.353,P=0.036), the state of vascular invasion(OR=33.392,95%CI=1.840~605.853,P=0.018) of tumors are associated with the No.8p lymph nodes metastasis and they were the independent influence factors.Conclusion: The incidence of No.8p lymph nodes metastasis was relatively high. No.8p lymph nodes metastasis was associated with the T stage, N stage of tumors in lower third advanced gastric cancer. Extended D2 lymphadenectomy including No.8p lymph nodes dissection couldn’t increase the patients’ 3-year long term survival. No.14 v lymph nodes metastasis was associated with the T stage, histologic type, Lauren type, the state of vascular invasion of tumors in lower third advanced gastric cancer. No.14 v lymph nodes metastasis significantly influenced the prognosis in the patients of lower third of the stomach. Extended D2 lymphadenectomy including No.14 v lymph nodes dissection seems to be associated with improved overall survival of patients.