Risk evaluation of splenic hilar lymph node metastasis and survival analysis of patients with advanced gastric cancer

Background:There is no consensus regarding the influence of prophylactic no.10 lymph node(LN)dissection in patients with advanced gastric cancer(AGC).We aimed to evaluate whether patients with AGC could benefit from no.10 LN dissection and to explore the clinicopathological indicators of no.10 LN metastasis.Methods:We analyzed the data of 218 patients with AGC who underwent standard D2 lymphadenectomy(SD2;n=108)or modified D2 lymphadenectomy(MD2;n=110)between January 2017 and January 2021.In addition,we examined factors influencing no.10 LN metastasis in the SD2 group.Results:Differentiation,tumor location,and no.4 positive LNs were significantly correlated with no.10 LN metastasis(P<0.05).Borrmann classification,differentiation,depth of invasion,LN metastasis(N),and tumor size were found to correlate with survival in univariate analyses.Age,sex,extent of gastrectomy,tumor location,and extent of lymphadenectomy were not associated with survival(P>0.05).The median survival times were 72.23 and 68.56months for the SD2 andMD2 groups,respectively(P=0.635).Postoperative major morbidity and mortality rates were 37.96%and 3.70%in the SD2 group,and 23.64%and 1.82%in the MD2 group,respectively.Conclusions:Based on our findings,prophylactic no.10 lymphadenectomy may be recommended in patients with AGC who exhibit positive no.4 LN status,poor differentiation,and tumors located on the greater curvature.

Hepatic Resection is Safe for Metachronous Hepatic Metastases from Ovarian Cancer

Objective To explore the efficacy of hepatic resection(HR) in a relatively unselected group of patients with ovarian cancer liver metastases(OCLM). Methods A study was conducted between September 2000 and September 2011 on 60 ovarian cancer patients with hepatic metastases(24 solitary and 36 multiple),40 of whom had extrahepatic metastases.HR was done in all patients provided that curative hepatic resection was feasible,and extrahepatic disease was controlled with medical and/or surgical therapy. Results Most patients(n=54;90.0% ) had a negative hepatic margin(R0),whereas 6 patients(10.0% ) had microscopic disease at the margin(R1).The prognostic value of each study variable was assessed using log rank tests for univariate analysis and Cox proportional hazard models for multivariate analysis.The result was a median survival of 39 months and 5-year overall survival rate of 30% .Univariate analysis showed that surgery result(P=0.001),disease free interval(P=0.018) and the number of hepatic lesions (P=0.018) were significantly related to survival.Furthermore,the surgery result(P=0.004) remained significant for prognosis in multivariate analysis. Conclusions For patients with OCLM,HR is safe and may provide a significant survival benefit compared with medical therapy alone.A long interval time,the number of hepatic lesions,and surgery results are key prognostic factors.Favorable outcomes can be achieved even in patients with medically controlled or surgically resectable extrahepatic disease,indicating that surgery should be considered more frequently in the multidisciplinary care of patients with OCLM.