Risk assessment of lymph node metastasis in early gastric cancer patients with vagus nerve-preserving gastrectomy: A multiple centers potential analysis in China.

Abstract

Vagus nerve-preserving gastrectomy is gaining popularity for early gastric cancer treatment. This study assesses vagus nerve-preserving gastrectomy's perioperative safety and impact on postoperative quality of life, and explores vagus nerve-associated lymph node metastasis to create a risk model for enhanced therapy. Clinicopathologic data from 1,210 early gastric cancer patients across 11 Chinese centers were analyzed, and the data of 800 patients with follow-up information and 48 patients who underwent vagus nerve-preserving gastrectomy for validation were collected. Propensity score matching was applied to the analysis of perioperative safety and quality of life in vagus nerve-preserving gastrectomy patients. A 6-point risk assessment model was devised and validated to evaluate the risk of vagus nerve-associated lymph node metastasis after vagus nerve-preserving gastrectomy in early gastric cancer patients. Vagus nerve-preserving gastrectomy patients had shorter postoperative stays, quicker drainage cessation, and fewer incidences of diarrhea, acid reflux, and postoperative gallstones. Additionally, key independent risk factors for vagus nerve-associated lymph node metastasis included tumor size, differentiation type, invasion depth, and lymphatic vessel invasion. Using these factors, a 6-point risk assessment model was established. The values of the area under the receiver operating characteristic curve for the model were 0.796, 0.806, 0.808, and 0.829 in the training cohort, internal validation cohort, external validation cohort, and vagus nerve-preserving gastrectomy cohort, respectively. The model effectively differentiated between high- and low-risk groups in terms of postoperative survival. Vagus nerve-preserving gastrectomy can improve the patients' postoperative quality of life and ensure safety in the perioperative period. The vagus nerve-associated lymph node metastasis risk assessment model is a crucial tool in guiding the selection of optimal surgical procedures and treatment strategies for early gastric cancer patients.