Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2023 May 10;18(5):e0285554. doi: 10.1371/journal.pone.0285554. eCollection 2023.
Clinical benefits of the meso-jejunal lymph node (MJLN) dissection in remnant gastric cancer (RGC) patients have not been fully established. Hence, in this retrospective study, we evaluated the survival benefit of MJLN dissection and prognostic significance of MJLN metastasis in RGC patients who underwent gastrojejunostomy reconstruction after their initial gastrectomy.
We retrospectively reviewed 391 patients who underwent surgery for RGC at our institution between 1996 and 2019. Among them, 60 patients had MJLN dissection. The index value of the survival benefit gained by dissection of the MJLN was calculated by multiplying the frequency of metastasis at the MJLN station and the 5-year overall survival rate (5YOS) of patients with metastasis at that station. When the metastatic rate or 5YOS exceeded 10%, dissection was recommended. An index value of dissection greater than 1.0 was considered significant.
Total metastatic rate of MJLN was 35% (n = 21/60). Patients with MJLN metastasis had advanced pathologic stage compared to patients in the no-metastasis group (p < 0.001). In T2-T4 RGC patients, the metastatic rate of MJLN was 48.6% (n = 17/35), and their 5YOS was 28.4%. The calculated index value was 13.8. Also, patients with MJLN metastasis had a poorer overall survival than those without metastasis. MJLN metastasis was an independent prognostic factor of overall survival in multivariate analysis (HR 6.77, 95%CI 2.21-20.79, p = 0.001).
MJLN dissection should be considered for advanced RGC patients who underwent gastrojejunostomy after distal gastrectomy during their initial surgery according to the index value.
胃切除术后行胃肠吻合术的残胃癌（RGC）患者中，中肠间淋巴结（MJLN）清扫的临床获益尚未完全确定。因此，在本回顾性研究中，我们评估了 MJLN 清扫对 RGC 患者的生存获益，以及 MJLN 转移对 RGC 患者的预后意义。
我们回顾性分析了 1996 年至 2019 年在我院行 RGC 手术的 391 例患者。其中，60 例患者行 MJLN 清扫。通过计算 MJLN 站转移的频率与该站转移患者的 5 年总生存率（5YOS）的乘积，计算获得的 MJLN 清扫的生存获益指数值。当转移率或 5YOS 超过 10%时，建议进行清扫。大于 1.0 的指数值被认为具有显著意义。
MJLN 的总转移率为 35%（n = 21/60）。与无转移组相比，有 MJLN 转移的患者具有更晚期的病理分期（p < 0.001）。在 T2-T4 RGC 患者中，MJLN 的转移率为 48.6%（n = 17/35），其 5YOS 为 28.4%。计算的指数值为 13.8。此外，有 MJLN 转移的患者总生存情况较无转移的患者更差。在多因素分析中，MJLN 转移是总生存的独立预后因素（HR 6.77，95%CI 2.21-20.79，p = 0.001）。
根据指数值，对于初次手术行远端胃切除术后行胃肠吻合术的晚期 RGC 患者，应考虑行 MJLN 清扫。
