Judgement Value of Preoperative MDCT on Radical Resection Extent for Advanced Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SU Yanzhuo ,  SUN Libo , SHU Zhenbo , DING Dayong , ZHENG Zelin

Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China;

Corresponding author：

SUN Libo, Email: sunlibo0431@sina.com

Keywords：

Gastric cancer; Lymph node metatasis; Radical resection; Computed tomography

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Objective To evaluate the role of preoperative 64 multi-detector spiral CT (MDCT) in predicting the extent of radical resection for advanced gastric cancer (AGC)．
Methods The imaging data of 70 patients with AGC were collected and analyzed. The N2 lymph node metastasis was predicted by the MDCT indications, and compared with that postoperative pathological results. Results Sixty-two patients were treated with surgical intervention. The sensitivity, specificity, and accuracy of N2 positive prediction by MDCT was 92.0% (46/50), 75.0% (9/12) and 88.7% (55/62), respectively. Extended resection was performed in 81.6% (40/49) patients who were predicted as N2 positive, and D2 resection was performed in 92.3% (12/13) patients who were predicted as N2 negative.
Conclusion The MDCT is a valuable technique to predict N2 lymph node metastasis, and to determine the extent of resection for AGC.

Citation： SU Yanzhuo,SUN Libo,SHU Zhenbo,DING Dayong,ZHENG Zelin. Judgement Value of Preoperative MDCT on Radical Resection Extent for Advanced Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(1): 25-28. doi: Copy

1.	Park JM, Kim YH. Current approaches to gastric cancer in Korea [J]. Gastrointest Cancer Res, 2008; 2(3): 137144.
2.	Díaz de Liao A, Yarnoz C, Aguilar R, et al. Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer [J]. Gastric Cancer, 2008; 11(2): 96102.
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7.	Ueda Y, Fujimura T, Kinami S, et al. A randomized phase Ⅲ trial of postoperative adjuvant therapy with S1 alone versus S1 plus PSK for stage Ⅱ/ⅢA gastric cancer: HokurikuKinki ImmunochemoTherapy Study GroupGastric Cancer (HKITGC) [J]. Jpn J Clin Oncol, 2006; 36(8): 519522.
8.	Ajani JA, Moiseyenko VM, Tjulandin S, et al. Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase Ⅲ trial of advanced gastric or gastroesophageal cancer adenocarcinoma: the V325 Study Group [J]. J Clin Oncol， 2007; 25(22): 32053209.
9.	Bouché O, Ychou M, Burtin P, Bedenne L, et al. Adjuvant chemotherapy with 5fluorouracil and cisplatin compared with surgery alone for gastric cancer: 7year results of the FFCD randomized phase Ⅲ trial (8801) [J]. Ann Oncol, 2005; 16(9): 14881497.
10.	Habermann CR,Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US [J]. Radiology, 2004; 230(2): 465471.
11.	Kim HS, Han HY, Choi JA, et al. Preoperative evaluation of gastric cancer:value of spiral CT during gastric arteriography (CTGA) [J]. Abdom Imaging, 2001; 26(2): 123130.
12.	黄娟, 潘彦辰, 周翔平, 等. 16 排螺旋CT 胃癌诊断和CTTNM 分期的价值 [J]. 中国普外基础与临床杂志, 2007; 14(6): 717721.
13.	姚学清, 林锋, 张忠林, 等. 64排CT三维血管重建术前对胃癌血管侵犯的评估 [J]. 中华胃肠外科杂志, 2008; 11(5): 440443.
14.	Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging [J]. Abdom Imaging, 2005; 30(4): 465472.
15.	BaSsalamah A, Prokop M, Uffmann M, et al. Dedicated multidetector CT of the stomach: spectrum of diseases [J]. Radiographics, 2003; 23(3): 625644.
16.	Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with paraaortic nodal dissection for gastric cancer [J]. N Engl J Med, 2008; 359(5): 453462.
17.	Yang SH, Zhang YC, Yang KH, et al. An evidencebased medicine review of lymphadenectomy extent for gastric cancer [J]. Am J Surg, 2009; 197(2): 246251.
18.	Nobuoka D, Gotohda N, Konishi M,et al. Prevention of postoperative pancreatic fistula after total gastrectomy [J]. World J Surg, 2008; 32(10): 22612266.
19.	Piso P, Bellin T, Aselmann H, et al. Results of combined gastrectomy and pancreatic resection in patients with advanced primary gastric carcinoma [J]. Dig Surg, 2002; 19(4): 281285.
20.	Okabayashi T, Kobayashi M, Sugimoto T, et al. Postoperative pancreatic fistula following surgery for gastric and pancreatic neoplasm; is distal pancreaticosplenectomy truly safe? [J]. Hepatogastroenterology, 2005; 52(61): 233236.
21.	Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006; 10(1): 132137.
22.	Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreratic lymph nodes [J]. Anticancer Res, 2002; 22(6B): 35133517.
23.	黄子星，陈心足，宋彬，等. 64排螺旋CT对Ⅳ期胃癌术前分期的价值 [J]. 中国普外基础与临床杂志, 2008; 8(15): 623627.
24.	Yang DM, Kim HC, Jin W, et al. 64 multidetectorrow computed tomography for preoperative evaluation of gastric cancer: histological correlation [J]. J Comput Assist Tomogr, 2007; 31(1): 98103.
25.	Lee SM, Kim SH, Lee JM, et al. Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer [J]. Abdom Imaging, 2009; 34(4): 430440.
26.	Gong JS, Zuo M, Yang P, et al. Value of CT in the diagnosis and followup of gastrointestinal stromal tumors [J]. Clin Imaging, 2008; 32(3): 172177.

1. Park JM, Kim YH. Current approaches to gastric cancer in Korea [J]. Gastrointest Cancer Res, 2008; 2(3): 137144.
2. Díaz de Liao A, Yarnoz C, Aguilar R, et al. Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer [J]. Gastric Cancer, 2008; 11(2): 96102.
3. 季加孚. 胃癌治疗的现状与趋势 [J]. 中国普外基础与临床杂志, 2006; 13(1): 13.
4. 朱正纲. 胃癌外科治疗相关问题的基本认识 [J]. 中国普外基础与临床杂志, 2008; 15(1): 13.
5. Kunisaki C, Akiyama H, Nomura M, et al. Comparison of surgical results of D2 versus D3 gastrectomy (paraaortic lymph node dissection) for advanced gastric carcinoma: A multiinstitutional study [J]. Ann Surg Oncol, 2006; 13(7): 659667.
6. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended paraaortic lymphadenectomyJapan Clinical Oncology Group study 9501 [J]. J Clin Oncol, 2004; 22(14): 27672773.
7. Ueda Y, Fujimura T, Kinami S, et al. A randomized phase Ⅲ trial of postoperative adjuvant therapy with S1 alone versus S1 plus PSK for stage Ⅱ/ⅢA gastric cancer: HokurikuKinki ImmunochemoTherapy Study GroupGastric Cancer (HKITGC) [J]. Jpn J Clin Oncol, 2006; 36(8): 519522.
8. Ajani JA, Moiseyenko VM, Tjulandin S, et al. Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase Ⅲ trial of advanced gastric or gastroesophageal cancer adenocarcinoma: the V325 Study Group [J]. J Clin Oncol， 2007; 25(22): 32053209.
9. Bouché O, Ychou M, Burtin P, Bedenne L, et al. Adjuvant chemotherapy with 5fluorouracil and cisplatin compared with surgery alone for gastric cancer: 7year results of the FFCD randomized phase Ⅲ trial (8801) [J]. Ann Oncol, 2005; 16(9): 14881497.
10. Habermann CR,Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US [J]. Radiology, 2004; 230(2): 465471.
11. Kim HS, Han HY, Choi JA, et al. Preoperative evaluation of gastric cancer:value of spiral CT during gastric arteriography (CTGA) [J]. Abdom Imaging, 2001; 26(2): 123130.
12. 黄娟, 潘彦辰, 周翔平, 等. 16 排螺旋CT 胃癌诊断和CTTNM 分期的价值 [J]. 中国普外基础与临床杂志, 2007; 14(6): 717721.
13. 姚学清, 林锋, 张忠林, 等. 64排CT三维血管重建术前对胃癌血管侵犯的评估 [J]. 中华胃肠外科杂志, 2008; 11(5): 440443.
14. Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging [J]. Abdom Imaging, 2005; 30(4): 465472.
15. BaSsalamah A, Prokop M, Uffmann M, et al. Dedicated multidetector CT of the stomach: spectrum of diseases [J]. Radiographics, 2003; 23(3): 625644.
16. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with paraaortic nodal dissection for gastric cancer [J]. N Engl J Med, 2008; 359(5): 453462.
17. Yang SH, Zhang YC, Yang KH, et al. An evidencebased medicine review of lymphadenectomy extent for gastric cancer [J]. Am J Surg, 2009; 197(2): 246251.
18. Nobuoka D, Gotohda N, Konishi M,et al. Prevention of postoperative pancreatic fistula after total gastrectomy [J]. World J Surg, 2008; 32(10): 22612266.
19. Piso P, Bellin T, Aselmann H, et al. Results of combined gastrectomy and pancreatic resection in patients with advanced primary gastric carcinoma [J]. Dig Surg, 2002; 19(4): 281285.
20. Okabayashi T, Kobayashi M, Sugimoto T, et al. Postoperative pancreatic fistula following surgery for gastric and pancreatic neoplasm; is distal pancreaticosplenectomy truly safe? [J]. Hepatogastroenterology, 2005; 52(61): 233236.
21. Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006; 10(1): 132137.
22. Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreratic lymph nodes [J]. Anticancer Res, 2002; 22(6B): 35133517.
23. 黄子星，陈心足，宋彬，等. 64排螺旋CT对Ⅳ期胃癌术前分期的价值 [J]. 中国普外基础与临床杂志, 2008; 8(15): 623627.
24. Yang DM, Kim HC, Jin W, et al. 64 multidetectorrow computed tomography for preoperative evaluation of gastric cancer: histological correlation [J]. J Comput Assist Tomogr, 2007; 31(1): 98103.
25. Lee SM, Kim SH, Lee JM, et al. Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer [J]. Abdom Imaging, 2009; 34(4): 430440.
26. Gong JS, Zuo M, Yang P, et al. Value of CT in the diagnosis and followup of gastrointestinal stromal tumors [J]. Clin Imaging, 2008; 32(3): 172177.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Judgement Value of Preoperative MDCT on Radical Resection Extent for Advanced Gastric Cancer

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