Is splenectomy for dissecting splenic hilar lymph nodes justified for scirrhous gastric cancer?

The concept of biopsy of sentinel lymph node as the first lymph node in the pathway of lymphogenous tumor spread has been actively discussed over the past decades and has already taken its rightful place in breast and melanoma surgery. The goal of this method is to exclude vain lymphadenectomy in patients without solid tumor metastases in regional lymph nodes. In the era of minimally invasive and organ-saving operations interventions it seems obvious an idea to introduce a biopsy of sentinel lymph node in surgery of early gastric cancer. Meanwhile the complexity of lymphatic system of the stomach and the presence of so-called skip metastases are factors limiting the introduction of a biopsy of sentinel lymph node in stomach cancer. This article presents a systematic analysis of biopsy technology of signaling lymph node as well as its safety and oncological adequacy. Based on literature data it seems to us that the special value of biopsy of sentinel lymph nodes in the future will be in the selection of personalized surgical tactics for stomach cancer.

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Determinant Factors on Differences in Survival for Gastric Cancer between the US and Japan Using Nationwide Databases: The Impact of Number of Lymph Nodes Examined

SSRN Electronic Journal ◽

10.2139/ssrn.3296687 ◽

2018 ◽

Author(s):

Yuri Ito ◽

Isao Miyashiro ◽

Takashi Ishikawa ◽

Kohei Akazawa ◽

Keisuke Fukui ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Determinant Factors ◽

The Us ◽

The Impact

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Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection

Scientific Reports ◽

10.1038/s41598-021-81663-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Honghu Wang ◽

Hao Qi ◽

Xiaofang Liu ◽

Ziming Gao ◽

Iko Hidasa ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Prognostic Index ◽

Staging System ◽

R0 Resection ◽

Remnant Gastric Cancer ◽

Curative Intent ◽

Node Ratio

AbstractThe staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Often, surgeries for RGC fail to achieve the > 15 lymph nodes needed for TNM staging. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retrieved lymph nodes (RLNs) for RGC between 2000 and 2014. The patients were divided into four groups on the basis of the NR cutoffs: rN0: 0; rN1: > 0 and ≤ 1/6; rN2: > 1/6 and ≤ 1/2; and rN3: > 1/2. The 5-year overall survival (OS) rates for rN0, rN1, rN2, and rN3 were 84.3%, 64.7%, 31.5%, and 12.7%, respectively. Multivariable analyses revealed that tumor size (p = 0.005), lymphovascular invasion (p = 0.023), and NR (p < 0.001), but not pN stage (p = 0.682), were independent factors for OS. When the RLN count is ≤ 15, the NR is superior to pN as an important and independent prognostic index of RGC, thus predicting the prognosis of RGC patients more accurately.

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Predicting gastric cancer outcome from resected lymph node histopathology images using deep learning

Nature Communications ◽

10.1038/s41467-021-21674-7 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Xiaodong Wang ◽

Ying Chen ◽

Yunshu Gao ◽

Huiqing Zhang ◽

Zehui Guan ◽

...

Keyword(s):

Gastric Cancer ◽

Deep Learning ◽

Lymph Node ◽

Lymph Nodes ◽

Main Method ◽

Learning Framework ◽

Prognostic Assessment ◽

N Stage ◽

Cancer Outcome ◽

Whole Slide Images

AbstractN-staging is a determining factor for prognostic assessment and decision-making for stage-based cancer therapeutic strategies. Visual inspection of whole-slides of intact lymph nodes is currently the main method used by pathologists to calculate the number of metastatic lymph nodes (MLNs). Moreover, even at the same N stage, the outcome of patients varies dramatically. Here, we propose a deep-learning framework for analyzing lymph node whole-slide images (WSIs) to identify lymph nodes and tumor regions, and then to uncover tumor-area-to-MLN-area ratio (T/MLN). After training, our model’s tumor detection performance was comparable to that of experienced pathologists and achieved similar performance on two independent gastric cancer validation cohorts. Further, we demonstrate that T/MLN is an interpretable independent prognostic factor. These findings indicate that deep-learning models could assist not only pathologists in detecting lymph nodes with metastases but also oncologists in exploring new prognostic factors, especially those that are difficult to calculate manually.

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IDDF2020-ABS-0149 Lymphadenectomy with optimal removed lymph nodes associated with improved staging and survival in stage I-III gastric cancer: is there an optimal cut-off point?

10.1136/gutjnl-2020-iddf.95 ◽

2020 ◽

Author(s):

Yang Li

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Stage I

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Evaluation of lymph node metastasis in patients with gastric cancer: a comparison of the directionality of lymph node metastasis and the total number of metastatic lymph nodes

Surgery Today ◽

10.1007/s00595-012-0454-8 ◽

2012 ◽

Vol 43 (2) ◽

pp. 130-135 ◽

Cited By ~ 3

Author(s):

Maki Kitagawa ◽

Daisuke Ichikawa ◽

Shuhei Komatsu ◽

Kazuma Okamoto ◽

Atsushi Shiozaki ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Metastatic Lymph Nodes ◽

Node Metastasis ◽

Metastatic Lymph

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Impact of the Number of Dissected Lymph Nodes on Survival for Gastric Cancer after Distal Subtotal Gastrectomy

Gastroenterology Research and Practice ◽

10.1155/2011/476014 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Chang-Ming Huang ◽

Jian-Xian Lin ◽

Chao-Hui Zheng ◽

Ping Li ◽

Jian-Wei Xie ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Lymph Nodes ◽

Distal Gastrectomy ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Prognostic Impact ◽

Term Survival

Objectives. To investigate the prognostic impact of the number of dissected lymph nodes (LNs) in gastric cancer after curative distal gastrectomy.Methods. The survival of 634 patients who underwent curative distal gastrectomy from 1995 to 2004 was retrieved. Long-term surgical outcomes and associations between the number of dissected LNs and the 5-year survival rate were investigated.Results. The number of dissected LNs was one of the most important prognostic indicators. Among patients with comparable T category, the larger the number of dissected LNs was, the better the survival would be (). The linear regression showed that a significant survival improvement based on increasing retrieved LNs for stage II, III and IV (). A cut-point analysis yields the greatest variance of survival rate difference at the levels of 15 LNs (stage I), 25 LNs (stage II) and 30 LNs (stage III).Conclusion. The number of dissected LNs is an independent prognostic factor for gastric cancer. To improve the long-term survival of patients with gastric cancer, removing at least 15 LNs for stage I, 25 LNs for stage II, and 30 LNs for stage III patients during curative distal gastrectomy is recommended.

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The Prognostic Value of Lymph Nodes Dissection Number on Survival of Patients with Lymph Node-Negative Gastric Cancer

Gastroenterology Research and Practice ◽

10.1155/2014/603194 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Wu Song ◽

Yujie Yuan ◽

Liang Wang ◽

Weiling He ◽

Xinhua Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Lymph Node ◽

Lymph Nodes ◽

Tumor Invasion ◽

Prognostic Value ◽

Operation Time ◽

Invasion Depth ◽

Node Negative ◽

Tumor Invasion Depth

Objective.The study was designed to explore the prognostic value of examined lymph node (LN) number on survival of gastric cancer patients without LN metastasis.Methods.Between August 1995 and January 2011, 300 patients who underwent gastrectomy with D2 lymphadenectomy for LN-negative gastric cancer were reviewed. Patients were assigned to various groups according to LN dissection number or tumor invasion depth. Some clinical outcomes, such as overall survival, operation time, length of stay, and postoperative complications, were compared among all groups.Results.The overall survival time of LN-negative GC patients was50.2±30.5months. Multivariate analysis indicated that LN dissection number(P<0.001)and tumor invasion depth(P<0.001)were independent prognostic factors of survival. The number of examined LNs was positively correlated with survival time(P<0.05)in patients with same tumor invasion depth but not correlated with T1 stage or examined LNs>30. Besides, it was not correlated with operation time, transfusion volume, length of postoperative stay, or postoperative complication incidence(P>0.05).Conclusions.The number of examined lymph nodes is an independent prognostic factor of survival for patients with lymph node-negative gastric cancer. Sufficient dissection of lymph nodes is recommended during surgery for such population.

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