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Received Oct 14, 2017; Accepted Mar 13, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Although the mortality of gastric cancer is declining as a result of the tremendous advances in therapeutic methods, it is still the second most common cause of cancer-related death in China and the world [1–3]. Recurrence and metastasis are the major threats to gastric cancer patients [4, 5]. Of all the metastatic patterns, lymphatic metastasis is most common. It is also an independent prognostic factor [6, 7], and therefore, special attention must be paid to lymphatic metastasis in gastric cancer patients.
Gastrectomy with lymph node dissection remains the first choice and standard treatment for the majority of gastric cancer patients. According to the Japanese Gastric Cancer Treatment Guidelines 2010 [8], only early gastric cancer (EGC) with differentiated histologic type or no lymph node metastasis is suitable for D1 and D1+ lymphadenectomy. Other EGC and advanced gastric cancer patients require D2 lymphadenectomy. However, this therapeutic strategy is too general. Every patient has unique clinicopathological features, and the therapeutic approach should be personalized to avoid the problem of over- and underdissection of lymph nodes.
Theoretically, the choice of the lymphadenectomy pattern must be strictly based on the metastatic scope. But, in fact, the status of lymph node metastasis cannot be accurately established even by pathological examination after operation, which is the gold standard test, let alone by other investigation results. A research from Japan, involving 929 patients, has reported that multidetector row CT (MDCT) could predict the preoperative N staging for resectable cT2–4 gastric carcinoma [9]. But only a few studies have focused on the metastatic scope of lymph nodes. We hypothesized that the results of preoperative investigations such as esophagogastroduodenoscopy (EGD), computed tomography (CT), and serum tumor marker levels could be used to roughly predict the metastatic scope, and on this basis, the best pattern of lymphadenectomy could be chosen for each patient. In this study, we present a novel concept, that is, to use preoperative examination results to formulate the treatment strategy, especially the extent of lymphadenectomy.
2. Materials and Methods
2.1. Data Sources and...