Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer
Super-extended (D2plus) lymphadenectomy after chemotherapy has been reported in only a few studies. This retrospective study evaluates survival outcomes in a Western cohort of locally advanced or oligometastatic gastric cancer patients who underwent D2plus lymphadenectomy after neoadjuvant chemother...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/16/7/1376 |
| _version_ | 1797212757525790720 |
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| author | Daniele Marrelli Stefania Angela Piccioni Ludovico Carbone Roberto Petrioli Maurizio Costantini Valeria Malagnino Giulio Bagnacci Gabriele Rizzoli Natale Calomino Riccardo Piagnerelli Maria Antonietta Mazzei Franco Roviello |
| author_facet | Daniele Marrelli Stefania Angela Piccioni Ludovico Carbone Roberto Petrioli Maurizio Costantini Valeria Malagnino Giulio Bagnacci Gabriele Rizzoli Natale Calomino Riccardo Piagnerelli Maria Antonietta Mazzei Franco Roviello |
| author_sort | Daniele Marrelli |
| collection | DOAJ |
| description | Super-extended (D2plus) lymphadenectomy after chemotherapy has been reported in only a few studies. This retrospective study evaluates survival outcomes in a Western cohort of locally advanced or oligometastatic gastric cancer patients who underwent D2plus lymphadenectomy after neoadjuvant chemotherapy. A total of 97 patients treated between 2010 and 2022 were included. Of these, 62 had clinical stage II/III disease, and 35 had stage IV disease. Most patients (65%) received preoperative DOC/FLOT chemotherapy. The mean number of lymph nodes harvested was 39. Pathological positive nodes in the posterior/para-aortic stations occurred in 17 (17.5%) patients. Lymphovascular invasion, ypN stage, clinical stage, and perineural invasion were predictive factors for positive posterior/para-aortic nodes. Postoperative complications occurred in 21 patients, whereas severe complications (grade III or more) occurred in 9 cases (9.3%). Mortality rate was 1%. Median overall survival (OS) was 59 months (95% CI: 13–106), with a five-year survival rate of 49 ± 6%; the five-year OS after R0 surgery was 60 ± 7%. In patients with positive posterior/para-aortic nodes, the median OS was 15 months (95% CI: 13–18). D2plus lymphadenectomy after chemotherapy for locally advanced or oligometastatic gastric cancer is feasible and associated with low morbidity/mortality rates. The incidence of pathological metastases in posterior/para-aortic nodes is not negligible even after systemic chemotherapy, with poor long-term survival. |
| first_indexed | 2024-04-24T10:47:27Z |
| format | Article |
| id | doaj.art-242f2464631e405c9c636b0148bc9a6c |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-04-24T10:47:27Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-242f2464631e405c9c636b0148bc9a6c2024-04-12T13:16:11ZengMDPI AGCancers2072-66942024-03-01167137610.3390/cancers16071376Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric CancerDaniele Marrelli0Stefania Angela Piccioni1Ludovico Carbone2Roberto Petrioli3Maurizio Costantini4Valeria Malagnino5Giulio Bagnacci6Gabriele Rizzoli7Natale Calomino8Riccardo Piagnerelli9Maria Antonietta Mazzei10Franco Roviello11Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Medical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyPathology Unit, University Hospital of Siena, 53100 Siena, ItalyPathology Unit, University Hospital of Siena, 53100 Siena, ItalyUnit of Diagnostic Imaging, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Kidney Transplantation, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Diagnostic Imaging, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, ItalySuper-extended (D2plus) lymphadenectomy after chemotherapy has been reported in only a few studies. This retrospective study evaluates survival outcomes in a Western cohort of locally advanced or oligometastatic gastric cancer patients who underwent D2plus lymphadenectomy after neoadjuvant chemotherapy. A total of 97 patients treated between 2010 and 2022 were included. Of these, 62 had clinical stage II/III disease, and 35 had stage IV disease. Most patients (65%) received preoperative DOC/FLOT chemotherapy. The mean number of lymph nodes harvested was 39. Pathological positive nodes in the posterior/para-aortic stations occurred in 17 (17.5%) patients. Lymphovascular invasion, ypN stage, clinical stage, and perineural invasion were predictive factors for positive posterior/para-aortic nodes. Postoperative complications occurred in 21 patients, whereas severe complications (grade III or more) occurred in 9 cases (9.3%). Mortality rate was 1%. Median overall survival (OS) was 59 months (95% CI: 13–106), with a five-year survival rate of 49 ± 6%; the five-year OS after R0 surgery was 60 ± 7%. In patients with positive posterior/para-aortic nodes, the median OS was 15 months (95% CI: 13–18). D2plus lymphadenectomy after chemotherapy for locally advanced or oligometastatic gastric cancer is feasible and associated with low morbidity/mortality rates. The incidence of pathological metastases in posterior/para-aortic nodes is not negligible even after systemic chemotherapy, with poor long-term survival.https://www.mdpi.com/2072-6694/16/7/1376D2plus lymphadenectomygastric cancerneoadjuvantconversionposterior nodespara-aortic nodes |
| spellingShingle | Daniele Marrelli Stefania Angela Piccioni Ludovico Carbone Roberto Petrioli Maurizio Costantini Valeria Malagnino Giulio Bagnacci Gabriele Rizzoli Natale Calomino Riccardo Piagnerelli Maria Antonietta Mazzei Franco Roviello Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer Cancers D2plus lymphadenectomy gastric cancer neoadjuvant conversion posterior nodes para-aortic nodes |
| title | Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer |
| title_full | Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer |
| title_fullStr | Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer |
| title_full_unstemmed | Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer |
| title_short | Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer |
| title_sort | posterior and para aortic d2plus lymphadenectomy after neoadjuvant conversion therapy for locally advanced oligometastatic gastric cancer |
| topic | D2plus lymphadenectomy gastric cancer neoadjuvant conversion posterior nodes para-aortic nodes |
| url | https://www.mdpi.com/2072-6694/16/7/1376 |
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