Metastasis to the lymph nodes along the proper hepatic artery from adenocarcinoma of the stomach

The study sought the significance of resecting lymph nodes along the proper hepatic artery (station 12a) in gastric cancer surgery and the possibility of predicting station 12a involvement from clinicopathological factors or metastatic status in other regional lymph nodes of the stomach.

Patients who underwent D2 gastrectomy were assessed retrospectively. Survivals were compared between the patients with and without station 12a metastasis among the patients with metastasis to any regional lymph nodes. Clinicopathological factors correlating with station 12a metastasis were sought by logistic regression analyses. The possibility of a predictor for station 12a metastasis was evaluated in each regional lymph node station.

Metastasis to station 12a was observed in 21 of 1260 patients (1.7 %). The 5-year overall survival rate was 62.7 % in the patients without station 12a metastasis and 54.4 % in the patients with station 12a metastasis (P = 0.164). The lower third (OR 3.810, 95 % CI 1.507–9.631, P = 0.005), the lesser curvature or circumferential involvement (OR 4.099, 95 % CI 1.178–14.259, P = 0.027) and 81.5 mm or larger tumor diameter (OR 2.959, 95 % CI 1.212–7.224, P = 0.017) were identified as the independent risk factors of station 12a metastasis. Station 11p significantly correlated with station 12a metastasis (OR 13.469, 95 % CI 1.437–126.216, P = 0.023). The false negatives as predictors of station 12a metastasis ranged from 14.3 % (station 6) to 100.0 % (station 11d) for each regional lymph node station.

Given the difficulty in predicting station 12a metastasis and the favorable survival in the patients with metastasis to the nodes, station 12a should be resected in a D2 gastrectomy.