Comparisons Between Different Procedures of No. 10 Lymphadenectomy for Gastric Cancer Patients With Total Gastrectomy

To compare the effectiveness and safety of in-vivo dissection procedure of No. 10 lymph nodes with those of ex-vivo dissection procedure for gastric cancer patients with total gastrectomy. Patients were divided into in-vivo group and ex-vivo group according to whether the dissection of No. 10 lymph nodes were performed after the mobilization of the pancreas and spleen, and migration out from peritoneal cavity. Clinicopathologic characteristics, overall survival, morbidity, and mortality were compared between the 2 groups. There were 148 patients in in-vivo group, while 30 in ex-vivo group. The baselines between the 2 groups were almost comparable. The metastatic ratio of No. 10 lymph nodes were 6.1% and 10.0% (P = 0.435) and the metastatic degree were 7.9% and 13.6% (P = 0.158) for in-vivo group and ex-vivo group, respectively. There was no difference in morbidity or mortality between the 2 groups. The number of total harvested lymph nodes and No. 10 lymph nodes increased significantly in ex-vivo group at the cost of prolonged operation time. The estimated overall survival rates for patients in in-vivo group and ex-vivo group were (3-year: 52.0% vs 61.8%) and (5-year: 45.3% vs 49.5%), respectively, without statistical significance. Further multivariable analysis had showed that the procedure of No. 10 lymphadenectomy was not a significant independent prognostic factor. Both in-vivo and ex-vivo dissection of No. 10 lymph nodes could be performed safely. It seems that ex-vivo dissection of No. 10 lymph nodes can result in a higher effective dissection at the cost of the operation time, but the overall survival rates were not statistically significant between the 2 groups, which should be confirmed further in a well-designed randomized controlled trial.