Assessment of Lymph Node Metastasis in Patients With Gastric Cancer to Identify Those Suitable for Middle Segmental Gastrectomy

Key Points Question Can metastasis at key lymph node (LN) stations be used to inform surgical management in patients with gastric cancer? Findings In this cohort study of 9952 patients who underwent surgery for gastric cancer, the rates of LN metastasis were 0% at LN station 5 for cT1-3N0/1M0 cancers, station 4sa for cT1-2N0/1M0 cancers, station 2 for cT1N0/1M0 cancers, station 6 for cT1N1M0 cancers, station 11d for cT1N1M0-cT2N0/1M0 cancers, and station 12a for cT1N0/1M0-T2N1M0 cancers, regardless of size and differentiation. Well-differentiated tumors were associated with lower rates of LN metastasis vs poorly differentiated tumors, and tumors 4 cm or smaller were also associated with lower rates of LN metastasis vs those 4.1 cm or larger. Meaning These findings suggest that middle segmental gastrectomy with dissection of LN stations 1, 3, 4sb, 4d, 7, 8a, 9, 11p, and 12a can be recommended for high-body and middle-body cT1N0/1M0 gastric cancers 4 cm or smaller and well-differentiated cT2N0/1M0 cancers.