Routine Modified D2 Lymphadenectomy Performance in PT1-T2N0 Gastric Cancer

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2009 Nov 26

PMID 19938196

Citations 4

Authors

John Griniatsos

Hara Gakiopoulou

Eugenia Yiannakopoulou

Nikoletta Dimitriou

Gerasimos Douridas

Afrodite Nonni

Theodoros Liakakos

Evangelos Felekouras

Affiliations

Soon will be listed here.

Abstract

Aim: To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemically detected skip micrometastases in level II lymph nodes.

Methods: Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0. All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the level I lymph node stations (n = 4) were excluded from further analysis. The level II lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study.

Results: Skip micrometastases in the level II lymph nodes were detected in 14% (4 out of 28) of the patients. The incidence was further increased to 17% (4 out of 24) in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No. 7 lymph node station. Thus, the disease was upstaged from stage IA to IB in one patient and from stage IB to II in three patients.

Conclusion: In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.

Citing Articles

Gastric cancer: Current status of lymph node dissection.

Degiuli M, De Manzoni G, Di Leo A, Dugo D, Galasso E, Marrelli D World J Gastroenterol. 2016; 22(10):2875-93.

PMID: 26973384 PMC: 4779911. DOI: 10.3748/wjg.v22.i10.2875.

Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer.

Verlato G, Giacopuzzi S, Bencivenga M, Morgagni P, De Manzoni G World J Gastroenterol. 2014; 20(36):12883-91.

PMID: 25278685 PMC: 4177470. DOI: 10.3748/wjg.v20.i36.12883.

Lymph node, peritoneal and bone marrow micrometastases in gastric cancer: Their clinical significance.

Griniatsos J, Michail O, Dimitriou N, Karavokyros I World J Gastrointest Oncol. 2012; 4(2):16-21.

PMID: 22403737 PMC: 3296804. DOI: 10.4251/wjgo.v4.i2.16.

Management and outcome of gastric carcinoma in Zaria, Nigeria.

Ahmed A, Ukwenya A, Makama J, Mohammad I Afr Health Sci. 2012; 11(3):353-61.

PMID: 22275924 PMC: 3261017.

References

Nakajima T . Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002; 5(1):1-5. DOI: 10.1007/s101200200000. View

Gretschel S, Bembenek A, Hunerbein M, Dresel S, Schneider W, Schlag P . Efficacy of different technical procedures for sentinel lymph node biopsy in gastric cancer staging. Ann Surg Oncol. 2007; 14(7):2028-35. DOI: 10.1245/s10434-007-9367-y. View

Shiozawa M, Akaike M, Yamada R, Godai T, Yamamoto N, Saito H . Clinicopathological features of skip metastasis in colorectal cancer. Hepatogastroenterology. 2007; 54(73):81-4. View

Yanagita S, Natsugoe S, Uenosono Y, Arigami T, Arima H, Kozono T . Detection of micrometastases in sentinel node navigation surgery for gastric cancer. Surg Oncol. 2008; 17(3):203-10. DOI: 10.1016/j.suronc.2008.04.008. View

Yamamoto N, Kato Y, Yanagisawa A, Ohta H, Takahashi T, Kitagawa T . Predictive value of genetic diagnosis for cancer micrometastasis: histologic and experimental appraisal. Cancer. 1997; 80(8):1393-8. DOI: 10.1002/(sici)1097-0142(19971015)80:8<1393::aid-cncr5>3.0.co;2-g. View

Lee S, Lee J, Ryu K, Cho S, Lee J, Kim C . Sentinel node mapping and skip metastases in patients with early gastric cancer. Ann Surg Oncol. 2009; 16(3):603-8. DOI: 10.1245/s10434-008-0283-6. View

Doekhie F, Mesker W, van Krieken J, Kok N, Hartgrink H, Kranenbarg E . Clinical relevance of occult tumor cells in lymph nodes from gastric cancer patients. Am J Surg Pathol. 2005; 29(9):1135-44. DOI: 10.1097/01.pas.0000160439.38770.cb. View

Domagala W, Bedner E, Chosia M, Weber K, Osborn M . Keratin-positive reticulum cells in fine needle aspirates and touch imprints of hyperplastic lymph nodes. A possible pitfall in the immunocytochemical diagnosis of metastatic carcinoma. Acta Cytol. 1992; 36(2):241-5. View

McCulloch P, Nita M, Kazi H, Gama-Rodrigues J . Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2004; (4):CD001964. DOI: 10.1002/14651858.CD001964.pub2. View

10.

Lee H, Kim M, Yang H, Lee B, Kim W . Prognostic implication of isolated tumor cells and micrometastases in regional lymph nodes of gastric cancer. World J Gastroenterol. 2005; 11(38):5920-5. PMC: 4436711. DOI: 10.3748/wjg.v11.i38.5920. View

11.

Iddings D, Bilchik A . Gastric carcinoma: applying the sentinel node paradigm to improve the understanding of metastatic patterns and the possible role of selective lymphadenectomy. Ann Surg Oncol. 2007; 14(9):2432-4. DOI: 10.1245/s10434-007-9411-y. View

12.

Folli S, Morgagni P, Roviello F, De Manzoni G, Marrelli D, Saragoni L . Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC). Jpn J Clin Oncol. 2001; 31(10):495-9. DOI: 10.1093/jjco/hye107. View

13.

Lee E, Chae Y, Kim I, Choi J, Yeom B, Leong A . Prognostic relevance of immunohistochemically detected lymph node micrometastasis in patients with gastric carcinoma. Cancer. 2002; 94(11):2867-73. DOI: 10.1002/cncr.10562. View

14.

Riquet M, Assouad J, Bagan P, Foucault C, Le Pimpec Barthes F, Dujon A . Skip mediastinal lymph node metastasis and lung cancer: a particular N2 subgroup with a better prognosis. Ann Thorac Surg. 2004; 79(1):225-33. DOI: 10.1016/j.athoracsur.2004.06.081. View

15.

Hartgrink H, van de Velde C . Status of extended lymph node dissection: locoregional control is the only way to survive gastric cancer. J Surg Oncol. 2005; 90(3):153-65. DOI: 10.1002/jso.20222. View

16.

Bonenkamp J, Songun I, Hermans J, Sasako M, Welvaart K, Plukker J . Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995; 345(8952):745-8. DOI: 10.1016/s0140-6736(95)90637-1. View

17.

Brennan M . Current status of surgery for gastric cancer: a review. Gastric Cancer. 2005; 8(2):64-70. DOI: 10.1007/s10120-005-0319-6. View

18.

Saito H, Tsujitani S, Ikeguchi M . Clinical significance of skip metastasis in patients with gastric cancer. Gastric Cancer. 2007; 10(2):87-91. DOI: 10.1007/s10120-007-0412-0. View

19.

Fukagawa T, Sasako M, Shimoda T, Sano T, Katai H, Saka M . The prognostic impact of isolated tumor cells in lymph nodes of T2N0 gastric cancer: comparison of American and Japanese gastric cancer patients. Ann Surg Oncol. 2009; 16(3):609-13. DOI: 10.1245/s10434-008-0290-7. View

20.

Morgagni P, Saragoni L, Scarpi E, Zattini P, Zaccaroni A, Morgagni D . Lymph node micrometastases in early gastric cancer and their impact on prognosis. World J Surg. 2003; 27(5):558-61. DOI: 10.1007/s00268-003-6797-y. View