1.Effect of standardized lymph node sorting on surgical treatment of gastroesophageal junction malignant tumors
Huihu He ; Kaiji Gao ; Jiahe Sun ; Qiyang Yao ; Shijie Zhang ; Lingjun Geng
Acta Universitatis Medicinalis Anhui 2024;59(8):1465-1470
Objective :
To investigate the effect of standardized lymph node sorting on postoperative results of gas- troesophageal junction malignant tumors.
Methods :
The data of all patients with malignant gastroesophageal junc- tion in gastric cancer database were analyzed retrospectively.Lymph nodes were sorted according to whether sur- geons were present immediately after surgery.Patients were divided into lymph node sorting group (sorting group) and lymph node unsorting group (unsorting group) .General data included gender,age,body mass index (BMI) , carcinogenic antigen ( CEA) ,postoperative albumin level,preoperative hemoglobin,etc.Perioperative and patho- logical data included operation time,intraoperative blood loss,postoperative hospital stay,tumor differentiation, distance from superior incisal margin,total number of lymph nodes,number of positive lymph nodes,etc.Kaplan- Meier curve and Log-rank test were used for survival analysis,and propensity score matching analysis adjusted for confounding factors between groups.
Results :
A total of 386 patients were included,including 133 in lymph node sorting group and 253 in non-sorting group.The median follow-up time was 40. 18 months.The total number of lymph nodes and the number of positive lymph nodes in the sorting group were (26. 38 ± 12. 18) and (6. 63 ± 10. 14) ,respectively,while the total number and the number of positive lymph nodes in the non-sorting group were ( 12. 25 ± 7. 06) and (3. 07 ± 3. 77) ,respectively.There were statistically significant differences in the total num- ber of lymph nodes and the number of positive lymph nodes between the sorting group and the non-sorting group (P <0. 05) .There was no statistically significant difference in survival between the sorting group and the non-sorting group before matching.There were 112 and 203 patients with advanced gastric cancer in the two groups,respec- tively.The overall survival curve of patients in the sorting group was better than that in the non-sorting group,and the difference in median survival time was statistically significant (P<0. 05) .The caliper value was set to 0. 02, and 94 pairs of patients were preferentially matched.After matching,the total number of lymph nodes and the num- ber of positive lymph nodes in the sorting group were (24. 71 ± 12. 03) and (5. 70 ± 9. 95) ,respectively,while the total number and the number of positive lymph nodes in the non-sorting group were ( 13. 05 ± 7. 63) and (3. 37 ± 4. 32) ,respectively.The difference between the two groups was statistically significant (P<0. 05) .The overall survival curve of patients in the sorting group was better than that in the non-sorting group,and the median survival time was statistically significant (P<0. 05) .
Conclusion
Postoperative lymph node sorting for gastric cancer can significantly increase the number of total lymph nodes and positive lymph nodes,reduce lymph node migration,and improve postoperative survival time.