Impact of Gastric Mesentery With Lymph Node Metastasis on Prognosis in Gastric Cancer Patients

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Total Enrollment

400 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-08-30

Study Completion Date

2030-08-30

Brief Summary

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This study aims to validate the predictive value of lymph node-metastasis gastric mesenteric regions and their quantitative involvement for gastric cancer prognosis by systematically examining lymph nodes from distinct mesenteric compartments in post-D2+CME radical gastrectomy specimens.

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Detailed Description

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Prior to 2010, the gastric cancer nodal staging systems primarily consisted of two approaches: the UICC/AJCC classification (by the International Union Against Cancer/American Joint Committee on Cancer), which was based principally on the number of metastatic lymph nodes; and the JGCA system (by the Japanese Gastric Cancer Association), which focused on the anatomical location of nodal metastases. However, a landmark unification occurred in the 14th edition of the Japanese Classification of Gastric Carcinoma (2010), where the anatomically-based nodal staging was abolished in favor of a metastasis-counting method. This harmonization with the UICC/AJCC system established a globally authoritative standard for evaluating therapeutic outcomes in gastric cancer, representing a milestone advancement in clinical research.

The current staging standard for gastric cancer follows the 8th edition TNM classification system (effective 2017) jointly established by the UICC (International Union Against Cancer) and AJCC (American Joint Committee on Cancer), which primarily evaluates tumor invasion depth (T), lymph node metastasis extent (N), and distant metastasis status (M). By integrating these three parameters, gastric cancer is classified into stages 0 through IV to guide treatment decisions and prognostic assessment. The gastric mesentery contains vascular, adipose, neural, and lymphoid tissues and can be anatomically divided into the left gastric mesentery, right gastric mesentery, left gastroepiploic mesentery, right gastroepiploic mesentery, posterior gastric mesentery, and short gastric mesentery. Although the anatomical location of metastatic lymph nodes is no longer included in the current gastric cancer staging system, our institutional research has demonstrated that among patients with the same N-stage, those with a greater number of lymph node-positive mesenteric regions exhibit worse prognosis, indicating that the anatomical distribution of nodal metastases remains clinically significant for gastric cancer outcomes. This study proposes to separately submit post-gastrectomy specimens with lymph nodes grouped by distinct mesenteric regions, with intraoperative demarcation of mesenteric boundaries during D2+CME surgery to achieve precise postoperative mesenteric sorting. Compared to the lymph node grouping method specified in the 15th edition of the Japanese Gastric Cancer Association's "Japanese Classification of Gastric Carcinoma" (2017), submitting lymph nodes according to mesenteric regions offers greater practicality. By examining gastric lymph nodes from separate mesenteric compartments, we aim to further investigate how the specific locations of lymph node-positive mesenteric regions and the total number of involved mesenteric areas impact gastric cancer patient prognosis, thereby enabling more accurate prediction of clinical outcomes.

Conditions

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Gastric Carcinoma

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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D2+CME surgery for gastric cancer

D2 lymphadenectomy plus complete mesogastric excision in gastric cancer patients

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

1. Aged older than 18 years and younger than 85 years
2. Primary gastric adenocarcinoma confirmed by preoperative pathology result
3. cT2-4aN0-3M0 at preoperative evaluation according to the American Joint 8 Committee on Cancer (AJCC) Cancer Staging Manual 8th Edition
4. Patients who received gastrectomy with D2 lymphadenectomy plus complete mesogastric excision
5. American Society of Anesthesiologists (ASA) class I, II, or III
6. Written informed consent

Exclusion Criteria

1. Negative preoperative biopsy
2. Too late tumour stage or metastasis (cT4b/M1)
3. BMI\>30 kg/m2
4. Total gastrectomy or proximal gastrectomy
5. previous neoadjuvant chemotherapy or radiotherapy
6. Previous upper abdominal surgery
7. Combined with other malignant diseases
8. Reject operation

Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No