Abstract:
Objective: It remains unclear whether the priority of nodal dissection is different depending on Types II and III.
Methods: The priority was evaluated by the therapeutic index, calculated by multiplying of the incidence of metastasis to each station by 5-year survival rate.
Results: A total of 176 patients (95 Type II and 81 Type III) were examined. The stations showing the first to fourth highest index were the right and left paracardial nodes (#1 and #2), lesser curvature node (#3), and the node at the root of the left gastric artery (#7) in the total cohort, as well as in each type. The fifth highest station in type II was the lower thoracic para-esophageal lymph node (#110), followed by the node along the proximal splenic artery (#11p), while that in type III was the node along the proximal splenic artery (#11p) followed by the para-aortic node (#16a2), the node at the celiac artery (#9), and the node around the splenic hilum (#10).
Conclusions: These results suggest that the highest priority nodal stations to be dissected were #1, #2, #3, and #7 regardless of the Siewert subtype, but the subsequent priority was different depending on the subtype.
