Research Article
Year 2019,
, 432 - 442, 30.06.2019
Abstract
References
- References1. Mc Culloch P, Nita ME, Kazi H, Gama-Rodriques J. Extended versus limited, lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database of Sistematic Reviews. 2003; (4) CD 001964 Cochrane Database Syst Rev.2. Quadri HS, SmagloBG,Morales SJ, et al. Gastric adenocarcinoma: Multimodal Approach. Front Surg 2017; 3: 4: 42.3. Wang H, Xing XM, Ma LN, et al. Metastatic lymph node ratio and Lauren classification are independent prognostic markers for survival rates of patients with gastric cancer. Oncol Lett 2018;15:6:8853-62.4. Pacelli F, Doglietto GB, Bellantone R, et al. Extensive versus limited lymph node dissection for gastric cancer: a comparative study of 320 patients. Br J Surg 1993; 80: 1153-56.5. Siewert JR, Böttcher K, Roder J, Busch R, Hermanek P, Meyer HJ. Prognostic relevance of systemic lymph node dissection in gastric carcinoma. German Gastric carcinoma Study Group. Br J Surg 1993; 80: 1015-18.6. Sue-Ling HM, Johnston D, Martin IG, et al. Gastric cancer: a curable disease in Britain BMJ 1993; 307: 591-96.7. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminarty results of the MRC randomised controlled surgical trial. Lancet 1996; 347: 995-99.8. Cuschieri A, Weeden S, Fielding J, et al. Patients survival after D1 and D2 resections for gastric cancer: long-term results of the MRC surgical trial. Brit J Cancer 1999; 79: 1522-30.9. Robertson CS, Chung SC, Woods SD, et al. A prospective randomised trial comparing R1, subtotal gastrectomy with R3 total gastrectomy for antral cancer. Ann Surg 1994; 220: 176-182.10. Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995; 345: 745-48.11. Bonenkamp JJ, Hermans J, Sasako M, Van de Velde CJ. Extended lymph node dissection for gastric cancer. NEJM 1999; 340: 908-58.12. Dent DM, Madden MV, Price SK. Randomised comparison of R1 and R2 gastrectomy for gastric carcinoma. Br J Surg. 1988; 75: 110-12.13. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J. Randomised clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg 2004; 91: 281-87.14. Dequili M, Sasako M, Calgaro M, et al. Italian gastric cancer study group. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interm analysis of the italian gastric cancer study group (IGCSG) randomised surgical trial. Eur J SurgOncol 2004; 30: 303-08.15. Sasako M, SanoT, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Eng J Med 2008; 359: 453-62.16. Japanese Gastric Cancer Association (JGCA). Japanese classification of gastric carcinoma-2nd English Edition. Gastric cancer 1998; 1:10-24.17. Sobin LH, Wittekind C. International Union Against Cancer (UICC) TNM classification of malignant tumours [M]. 6th edition. New York: Wiley, 2002: 70-72.18. Asoglu O, Matlim T, Kurt A, et al. Guidelines for Extended lymphadenectomy in gastric cancer: A prospective comparative study. AnnSurgOncol 2013; 20: 218-25.19. Maruyama K. The most important prognostic factors for gastric cancer patients: A study Using Univariate and Multivariate analysesScand J Gastroenterol 1988; 22: 63-68.20. Asoglu O, Karanlik H, Parlak M, et al. Metastatic lymph node ratio is an independent prognostic factor in gastric cancer. Hepatogastroenterology 2009; 56: 908-13. 21. Degiuli M, De Manzoni G, Di Leo A, et al. GAstric cancer: Current status of lymph node dissection. World J Gastroenterol 2016; 22: 10: 2875-93. 22. Noguchi Y, Imada T, Matsumoto A, Coit DG, Brennan MF. Radical surgery for gastric cancer. Cancer 1989; 64: 2053-62.23. Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T. Lymph node metastasis of gastric cancer. Ann Surg. 1989; 210: 596-602.24. Noguchi Y, Yoshikawa T, Tsuburuya A, Motohashi H, Karpeh MS, Brennah MF. Is gastric cancinoma different between Japan and the United States. Cancer 2000; 89: 2237-4625. Kulig J, Popiela T, Kolodziejczyk P, Sierzega M, Szczepanik A; Polish Gastric Cancer Study Group. Standart D2 versus extended D2 lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomised clinical trial. Am J Surg 2007; 193: 10-15.26. Dequili M, Sasako M, Ponzetto A, et al. Extended lymph node dissection for gastric cancer: results of a prospective multi-center analysis of morbidity and mortality in 118 consecutive patients. Eur J of SurgOncol 1997; 23: 310-14.27. Siewert JR, Böttcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998; 228: 449-61.28. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomised controlled trial comparing D2 and extended para-aortic lymphadenectomy. Japan clinical oncology group study 9501. J ClinOncol 2004; 22: 2767-73.29. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ. Quality control of lymph node dissection in the Dutch randomized trial of D1 and D2 lymph node dissection for gastric cancer. Gastric Cancer 1998; 1: 152-59.30. Bunt AM, Hermans J, van de Velde CJ, et al. Lymph node retrieval in a randomized trial on Western-type versus Japanese type surgery in gastric cancer. J ClinOncol 1996; 14: 2289-99.31. Wagner PK, Ramaswamy A, Rüschoff J, Schmitz-Moormann P, Rothmund M. Lymph node counts in the upper abdomen: anatomical basis for lymphadenectomy in gastric cancer. Br J Surg 1991; 7 8: 825-27.32. Aurello P, D’Angelo F, Rossi S, et al. Classification of lymph node metastases from gastric cancer: comparison between N-site and N-number systems. Our experience and review of the literature. Am J Surg 2007; 73: 359-66.33. Kodera Y, Yamamura Y, Shimizu Y, et al. The number of metastatic lymph nodes: a promising prognostic determinant for gastric carcinoma in the latest edition of the TNM classification. J Am CollSurg 1998; 187: 597-603.34. Park SS, Ryu JS, Min BW, et al. Impact of skip metastasis in gastric cancer. Anz J Surg 2005; 75: 645-49.35. Kikuchi S, Kurita A, Natsuya K, et al. First dranaige lymph node(s) in gastric cancer: analysis of the topographical pattern of lymph node metastasis in patient with pN1 tumors, Anticancer Res 2003; 23: 601-04.36. Arai K, Iwaski Y, Takahashi T. Clinicopathological analysis of early gastric cancer with solitary lymph node metastasis. Br J Surg 2002; 89: 1435-37.37. Saito H, Tsujinati S, Ikequchi M. Clinical signifiance of skip metastasis in patients with gastric cancer. Gastric Cancer 2007; 10: 87-91.38. Bunt AM, Hermans J, Smit VT, et al.Surgical pathologic stage migration confounds comparisons of gastric cancer survival rates between Japan and western countries. J of Clin Oncol 1995; 13: 19-25.
Does the number of lymph nodes harvested reflect the width of lymphadenectomy in gastric carcinoma? Results of a prospective comparative study
Abstract
Objective: The aim
of this study was to evaluate the sufficiency of the surgical technique
according to the extended lymph node dissection in gastric cancer patients
(GCPs). We supported our findings with the determination of number of lymph
nodes (LNs) in lymph node stations with an autopsy performed on cadavers
without any type of cancer.
Method: 55 GCPs
were enrolled. Extended lymphadenectomy was performed on 23 autopsy cases as a
comparative group. Total gastrectomy and D2 dissection was performed as the
standard surgical approach.
Results: According to TNM classification, nine cases
(18%) were stratified to stage I, three (6%) to stage II, 22 (36%) to stage
III, and 21 (40%) to stage IV. The median number of excised LNs from the 55
cases was 47 (24-95), metastatic LNs were 15 (1-71) in patients. In the autopsy
group the median number was 72 (50-91). If D1 dissection had been performed
instead of D2 dissection in the 55 cases, the median number of excised LNs
would have been 24 (10–57) and metastatic LNs would have been 5 (1–45). If D1
dissection had been performed in the autopsy group, the median number of
excised LNs would have been 36 (20–49).
Conclusions: The
number of LNs harvested does not reflect the width of lymphadenectomy. D2
dissection must be performed stationary to achieve adequate extension of the
lymphadenectomy. Possible skip metastasis and stage migration will be also
reduced so that more efficient oncological results will be achieved.
References
- References1. Mc Culloch P, Nita ME, Kazi H, Gama-Rodriques J. Extended versus limited, lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database of Sistematic Reviews. 2003; (4) CD 001964 Cochrane Database Syst Rev.2. Quadri HS, SmagloBG,Morales SJ, et al. Gastric adenocarcinoma: Multimodal Approach. Front Surg 2017; 3: 4: 42.3. Wang H, Xing XM, Ma LN, et al. Metastatic lymph node ratio and Lauren classification are independent prognostic markers for survival rates of patients with gastric cancer. Oncol Lett 2018;15:6:8853-62.4. Pacelli F, Doglietto GB, Bellantone R, et al. Extensive versus limited lymph node dissection for gastric cancer: a comparative study of 320 patients. Br J Surg 1993; 80: 1153-56.5. Siewert JR, Böttcher K, Roder J, Busch R, Hermanek P, Meyer HJ. Prognostic relevance of systemic lymph node dissection in gastric carcinoma. German Gastric carcinoma Study Group. Br J Surg 1993; 80: 1015-18.6. Sue-Ling HM, Johnston D, Martin IG, et al. Gastric cancer: a curable disease in Britain BMJ 1993; 307: 591-96.7. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminarty results of the MRC randomised controlled surgical trial. Lancet 1996; 347: 995-99.8. Cuschieri A, Weeden S, Fielding J, et al. Patients survival after D1 and D2 resections for gastric cancer: long-term results of the MRC surgical trial. Brit J Cancer 1999; 79: 1522-30.9. Robertson CS, Chung SC, Woods SD, et al. A prospective randomised trial comparing R1, subtotal gastrectomy with R3 total gastrectomy for antral cancer. Ann Surg 1994; 220: 176-182.10. Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995; 345: 745-48.11. Bonenkamp JJ, Hermans J, Sasako M, Van de Velde CJ. Extended lymph node dissection for gastric cancer. NEJM 1999; 340: 908-58.12. Dent DM, Madden MV, Price SK. Randomised comparison of R1 and R2 gastrectomy for gastric carcinoma. Br J Surg. 1988; 75: 110-12.13. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J. Randomised clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg 2004; 91: 281-87.14. Dequili M, Sasako M, Calgaro M, et al. Italian gastric cancer study group. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interm analysis of the italian gastric cancer study group (IGCSG) randomised surgical trial. Eur J SurgOncol 2004; 30: 303-08.15. Sasako M, SanoT, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Eng J Med 2008; 359: 453-62.16. Japanese Gastric Cancer Association (JGCA). Japanese classification of gastric carcinoma-2nd English Edition. Gastric cancer 1998; 1:10-24.17. Sobin LH, Wittekind C. International Union Against Cancer (UICC) TNM classification of malignant tumours [M]. 6th edition. New York: Wiley, 2002: 70-72.18. Asoglu O, Matlim T, Kurt A, et al. Guidelines for Extended lymphadenectomy in gastric cancer: A prospective comparative study. AnnSurgOncol 2013; 20: 218-25.19. Maruyama K. The most important prognostic factors for gastric cancer patients: A study Using Univariate and Multivariate analysesScand J Gastroenterol 1988; 22: 63-68.20. Asoglu O, Karanlik H, Parlak M, et al. Metastatic lymph node ratio is an independent prognostic factor in gastric cancer. Hepatogastroenterology 2009; 56: 908-13. 21. Degiuli M, De Manzoni G, Di Leo A, et al. GAstric cancer: Current status of lymph node dissection. World J Gastroenterol 2016; 22: 10: 2875-93. 22. Noguchi Y, Imada T, Matsumoto A, Coit DG, Brennan MF. Radical surgery for gastric cancer. Cancer 1989; 64: 2053-62.23. Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T. Lymph node metastasis of gastric cancer. Ann Surg. 1989; 210: 596-602.24. Noguchi Y, Yoshikawa T, Tsuburuya A, Motohashi H, Karpeh MS, Brennah MF. Is gastric cancinoma different between Japan and the United States. Cancer 2000; 89: 2237-4625. Kulig J, Popiela T, Kolodziejczyk P, Sierzega M, Szczepanik A; Polish Gastric Cancer Study Group. Standart D2 versus extended D2 lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomised clinical trial. Am J Surg 2007; 193: 10-15.26. Dequili M, Sasako M, Ponzetto A, et al. Extended lymph node dissection for gastric cancer: results of a prospective multi-center analysis of morbidity and mortality in 118 consecutive patients. Eur J of SurgOncol 1997; 23: 310-14.27. Siewert JR, Böttcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998; 228: 449-61.28. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomised controlled trial comparing D2 and extended para-aortic lymphadenectomy. Japan clinical oncology group study 9501. J ClinOncol 2004; 22: 2767-73.29. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ. Quality control of lymph node dissection in the Dutch randomized trial of D1 and D2 lymph node dissection for gastric cancer. Gastric Cancer 1998; 1: 152-59.30. Bunt AM, Hermans J, van de Velde CJ, et al. Lymph node retrieval in a randomized trial on Western-type versus Japanese type surgery in gastric cancer. J ClinOncol 1996; 14: 2289-99.31. Wagner PK, Ramaswamy A, Rüschoff J, Schmitz-Moormann P, Rothmund M. Lymph node counts in the upper abdomen: anatomical basis for lymphadenectomy in gastric cancer. Br J Surg 1991; 7 8: 825-27.32. Aurello P, D’Angelo F, Rossi S, et al. Classification of lymph node metastases from gastric cancer: comparison between N-site and N-number systems. Our experience and review of the literature. Am J Surg 2007; 73: 359-66.33. Kodera Y, Yamamura Y, Shimizu Y, et al. The number of metastatic lymph nodes: a promising prognostic determinant for gastric carcinoma in the latest edition of the TNM classification. J Am CollSurg 1998; 187: 597-603.34. Park SS, Ryu JS, Min BW, et al. Impact of skip metastasis in gastric cancer. Anz J Surg 2005; 75: 645-49.35. Kikuchi S, Kurita A, Natsuya K, et al. First dranaige lymph node(s) in gastric cancer: analysis of the topographical pattern of lymph node metastasis in patient with pN1 tumors, Anticancer Res 2003; 23: 601-04.36. Arai K, Iwaski Y, Takahashi T. Clinicopathological analysis of early gastric cancer with solitary lymph node metastasis. Br J Surg 2002; 89: 1435-37.37. Saito H, Tsujinati S, Ikequchi M. Clinical signifiance of skip metastasis in patients with gastric cancer. Gastric Cancer 2007; 10: 87-91.38. Bunt AM, Hermans J, Smit VT, et al.Surgical pathologic stage migration confounds comparisons of gastric cancer survival rates between Japan and western countries. J of Clin Oncol 1995; 13: 19-25.
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Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Surgical Science Research Articles |
| Authors | |
| Publication Date | June 30, 2019 |
| Acceptance Date | June 29, 2019 |
| Published in Issue | Year 2019 |