J Gastric Cancer.  2017 Jun;17(2):186-191. 10.5230/jgc.2017.17.e13.

Five-year Survival Associated with Stage I Gastric Cancer after Resection of Early Recurrence at Nodal Station No. 14v: a Case Report

• Abe I
• Kinoshita
• Kaito A
• Sunagawa H
• Watanabe M
• Sugita S
• Tonouchi A
• Sato R

• KMID: 2383742
• DOI: http://doi.org/10.5230/jgc.2017.17.e13

Abstract

The role of nodal station No. 14v (along the superior mesenteric vein) in lymphadenectomy for distal gastric cancer remains elusive. A 73-year-old woman underwent endoscopic submucosal dissection for gastric cancer, and was referred to our division for additional surgery because of pathologically non-curative resection. A laparoscopic distal gastrectomy with D1+ dissection was performed, with a final diagnosis of pT1bN1M0, Stage IB (2 nodal metastases to No. 6). Four months post-surgery, abdominal computed tomography revealed a 14-mm solitary nodule along the superior mesenteric vein. The lesion was excised and pathologically identified as a lymph node metastasis. Adjuvant chemotherapy with tegafur-gimeracil-oteracil potassium (S-1) was administered for the metastasis. Presently the patient survives without recurrence, 5.5 years after the second operation. Our findings suggest that there is lymphatic flow from the No. 6 to the No. 14v nodal station. Some patients with a No. 6 metastasis may benefit from a No. 14v lymphadenectomy, even in early-staged disease.

Keyword

Early detection of cancer; Stomach neoplasms; Lymph nodes; Surgical treatment

MeSH Terms

Aged
Chemotherapy, Adjuvant
Diagnosis
Early Detection of Cancer
Female
Gastrectomy
Humans
Lymph Node Excision
Lymph Nodes
Mesenteric Veins
Neoplasm Metastasis
Potassium
Recurrence*
Stomach Neoplasms*
Potassium

Figure

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  Fig. 1 Endoscopic view of the lesion before ESD. Upper gastrointestinal endoscopy revealed an elevated tumor (Type 0–I) at the greater curvature of the antrum. ESD = endoscopic submucosal dissection.

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  Fig. 2 Specimen from endoscopic submucosal resection. En bloc resection was achieved without perforation.

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  Fig. 3 CT image showing a nodule 14×12 mm in size (yellow arrow), detected at the left side of the superior mesenteric vein. CT = computed tomography.

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  Fig. 4 PET-CT image showing accumulation of fluorodeoxyglucose (yellow arrow). PET-CT = positron emission tomography-computed tomography.

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