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Background <p>The necessity of dissecting station 1 (right paracardial) and 4Sb (left gastroepiploic artery) lymph nodes (LNs) during radical distal gastrectomy for gastric cancer remains debated. This study investigated their therapeutic value for lower-third (LGC) and middle-third (MGC) gastric cancer.</p> Methods <p>This retrospective cohort study analyzed 897 patients undergoing radical distal gastrectomy (2013–2019). Metastasis rates, clinicopathological associations, multivariate analyses for risk factors and survival and therapeutic value index (TVI = metastasis frequency × 5-year survival of station-positive patients) for stations 1 and 4Sb were assessed, stratified by tumor location.</p> Results <p>For LGC (<i>n</i> = 435), station 4Sb showed a 0.46% metastasis rate and a 0% TVI. In contrast, station 1 had a 5.06% metastasis rate and a TVI of 4.14%. Multivariate survival analysis for LGC revealed that after adjusting for T and N stage, station 1 metastasis was not an independent prognostic factor for overall survival (HR 1.60, 95% CI 0.95–2.71, <i>p</i> = 0.078). For MGC (<i>n</i> = 462), station 1 metastasis was an independent prognostic factor (HR 1.75, 95% CI 1.08–2.83, <i>p</i> = 0.023).</p> Conclusions <p>Routine dissection of station 4Sb LNs in LGC offers negligible survival benefit. Furthermore, given that station 1 metastasis is not an independent prognostic factor in LGC, its routine dissection also warrants reconsideration. These findings support a biology-driven refinement of lymphadenectomy guidelines, suggesting that omitting station 4Sb and selectively omitting station 1 in LGC may be oncologically safe. Prospective validation is crucial.</p>

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Therapeutic value of dissecting stations 1 and 4Sb lymph nodes during radical distal gastrectomy for lower- and middle-third gastric cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月22日

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  • Peng Liao,
  • Ren-hao Hu,
  • Xi-mao Cui,
  • Shun Zhang,
  • Xiao-hua Jiang

摘要

Background

The necessity of dissecting station 1 (right paracardial) and 4Sb (left gastroepiploic artery) lymph nodes (LNs) during radical distal gastrectomy for gastric cancer remains debated. This study investigated their therapeutic value for lower-third (LGC) and middle-third (MGC) gastric cancer.

Methods

This retrospective cohort study analyzed 897 patients undergoing radical distal gastrectomy (2013–2019). Metastasis rates, clinicopathological associations, multivariate analyses for risk factors and survival and therapeutic value index (TVI = metastasis frequency × 5-year survival of station-positive patients) for stations 1 and 4Sb were assessed, stratified by tumor location.

Results

For LGC (n = 435), station 4Sb showed a 0.46% metastasis rate and a 0% TVI. In contrast, station 1 had a 5.06% metastasis rate and a TVI of 4.14%. Multivariate survival analysis for LGC revealed that after adjusting for T and N stage, station 1 metastasis was not an independent prognostic factor for overall survival (HR 1.60, 95% CI 0.95–2.71, p = 0.078). For MGC (n = 462), station 1 metastasis was an independent prognostic factor (HR 1.75, 95% CI 1.08–2.83, p = 0.023).

Conclusions

Routine dissection of station 4Sb LNs in LGC offers negligible survival benefit. Furthermore, given that station 1 metastasis is not an independent prognostic factor in LGC, its routine dissection also warrants reconsideration. These findings support a biology-driven refinement of lymphadenectomy guidelines, suggesting that omitting station 4Sb and selectively omitting station 1 in LGC may be oncologically safe. Prospective validation is crucial.