How many lymph nodes is enough? Defining the optimal lymph node dissection in stage I-III gastric cancer using the National Cancer Database.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4034-4034
Author(s):  
Karna Tushar Sura ◽  
Hong Ye ◽  
Charles C Vu ◽  
John M. Robertson ◽  
Peyman Kabolizadeh
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Surgical Resection ◽  
Lymph Node Dissection ◽  
Optimal Number ◽  
Sensitivity Analyses ◽  
Stage Migration ◽  
National Cancer Database ◽  
Node Dissection

4034 Background: Gastric cancer is one of the most causes of cancer-related death worldwide. Surgical resection with lymph node dissection is the primary therapeutic modality. However, the appropriate extent of lymph node dissection remains controversial. Herein, the National Cancer Database (NCDB) was used to determine the optimal number of lymph nodes (LNs) to be dissected for resectable gastric cancer. Methods: The NCDB was queried from 2004-2013 for patients with invasive gastric cancer who underwent surgical resection with negative margins. The optimal number of LNs dissected was determined using a univariate χ2 cut-point analysis. Actuarial survival was determined using the Kaplan Meier method, and comparisons of survival estimates were completed with log-rank tests. Multiple sensitivity analyses were utilized to decrease bias. Results: 17,851 patients were included. The mean (±SD) number of LNs examined was 16 ± 11. For all patients, the optimal number of LNs needed to be examined was 20+ nodes. When correcting for stage migration ( < 7 LNs removed), the optimal cut-off value was 20+ LNs. When stratifying by pathologic nodal stage, the cutpoint was 10+ LNs for pN1 and pN2. The 5-year survival was 30.6 ± 1.6% for 0-9 removed LNs compared to 48.2 ± 1.2% for 10+ removed LNs (p < 0.001) in pN1 disease and 18.3 ± 1.7% for 0-9 removed LNs compared to 32.6 ± 1.2% for 10+ removed LNs (p < 0.001) in pN2 disease. For pN3 disease, the optimal cut-off point was 20+ LNs; the 5-year survival was 17.2 ± 1.3% for 0-19 removed LNs compared to 28.5 ± 1.7% for 20+ removed LNs (p < 0.001). Moreover, the outcome was inferior among patients who had > 10% positive dissected LNs (p < 0.05). Conclusions: The optimal number of dissected LNs of 20+ LNs was associated with superior survival. Extended LN dissection is to be considered especially in patients with > 10% positive dissected LNs.

Left Gastric Artery Lymph Nodes Should Be Included in D1 Lymph Node Dissection in Gastric Cancer

2017 ◽  
Vol 21 (10) ◽  
pp. 1563-1570 ◽  
Author(s):  
Naruhiko Ikoma ◽  
Mariela Blum ◽  
Jeannelyn S. Estrella ◽  
Xuemei Wang ◽  
Keith F. Fournier ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Left Gastric Artery ◽  
Node Dissection ◽  
Gastric Artery

scholarly journals Safety and Feasibility of No.12a Lymph Node Dissection by Portal Vein Approach in Radical Laparoscopic Gastrectomy for Gastric Cancer

2020 ◽  
Vol 19 ◽  
pp. 153303382097127
Author(s):  
Hai-Peng Huang ◽  
Wen-Jun Xiong ◽  
Yao-Hui Peng ◽  
Yan-Sheng Zheng ◽  
Li-Jie Luo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Blood Loss ◽  
Portal Vein ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Intraoperative Blood Loss ◽  
Node Dissection ◽  
Metastasis Rate ◽  
The Mean

Background: Traditional laparoscopic No.12a lymph node dissection in radical gastrectomy for gastric cancer may damage the peripheral blood vessels, and is not conducive to the full exposure of the portal vein and the root ligation of the left gastric vein. We recommend a new surgical procedure, the portal vein approach, to avoid these problems. Methods: 25 patients with advanced gastric cancer underwent radical laparoscopic gastrectomy and No.12a lymph node were dissected by portal vein approach, including 7 cases with total gastrectomy, 18 cases with distal gastric resection, 14 males and 11 females. Operative time, intraoperative blood loss, time to first flatus, postoperative hospital stay, number of total lymph node dissection and No.12a lymph node dissection, No.12a lymph node metastasis rate and postoperative complications were statistically observed. Results: All the patients were operated successfully and No.12a lymph node were cleaned by portal vein approach. A total of 683 lymph nodes were dissected, with the average number of lymph nodes dissection and positive lymph nodes were (27.3 ± 12.7) and (3.8 ± 5.6) respectively. The average number of No.12a lymph node dissection was (2.4 ± 1.95) and the metastasis rate of No.12a lymph node was 16% (4/25). The average operation time of radical laparoscopic distal and total gastrectomy were (239.2 ± 51.4) min and (295.1 ± 27.7) min respectively. The mean intraoperative blood loss was (134.0 ± 65.7) ml, and postoperative first anal exhaust time was (2.24 ± 0.86) d. The mean time to fluid intake was (4.2 ± 1.7) d, and postoperative hospitalization time was (9.6 ± 5.0) d. Without portal vein injure, anastomotic leakage, gastrointestinal bleeding, intestinal obstruction and other complications were observed in all patient. Conclusion: Our results show that the laparoscopic No.12a lymph node dissection by portal vein approach for gastric cancer is safe, feasible and has certain clinical application value.

Left Gastric Artery Lymph Nodes Should be Included in D1 Lymph Node Dissection in Gastric Cancer

2017 ◽  
Vol 152 (5) ◽  
pp. S1287-S1288 ◽  
Author(s):  
Naruhiko Ikoma ◽  
Mariela Blum ◽  
Jeannelyn Estrella ◽  
Keith Fournier ◽  
Paul Mansfield ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Left Gastric Artery ◽  
Node Dissection ◽  
Gastric Artery

Can Superextended Lymph Node Dissection be Justified for Gastric Cancer with Pathologically Positive Para-aortic Lymph Nodes?

2010 ◽  
Vol 17 (8) ◽  
pp. 2031-2036 ◽  
Author(s):  
Masanori Tokunaga ◽  
Shigekazu Ohyama ◽  
Naoki Hiki ◽  
Tetsu Fukunaga ◽  
Susumu Aikou ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Node Dissection

scholarly journals Possibilities of performance of nonstandard operative interventions in patients, suffering early gastric cancer

2019 ◽  
Vol 86 (11-12) ◽  
pp. 51-55
Author(s):  
V. V. Grubnik ◽  
Yu. V. Grubnik ◽  
R. P. Nikitenko
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Lymph Node ◽  
Early Gastric Cancer ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Sentinel Lymph Nodes ◽  
Disease Stage ◽  
Node Dissection

Objective. To study a possibility of performance of nonstandard organ-preserving operations in patients, suffering early gastric cancer, using application of the sentinel lymph nodes visualization procedures and the lymph node dissection procedure. Materials and methods. There were performed operative interventions in 35 patients, suffering early gastric cancer (Stages T1 and T2). For identification of sentinel lymph nodes a procedure of luminescence, using green indocyan, was applied. Results.  In all the patients early gastric cancer was diagnosed (T1,T2). Possibility for performance of organ-preserving operations in early gastric cancer was shown. Miniinvasive interventions in a patient with severe concurrent diseases have appeared sufficiently effective and radical. The patients’ quality of life after laparoscopic pylorus-preserving and organ-preserving operations was significantly better, than quality of life in patients, to whom gastric resection with extended D2 lymph node dissection was done. Conclusion. There was established, that intraoperative lymphography constitutes he informative method, which helps to estimate the disease Stage in gastric cancer and to apply the adequate scheme of combined and complex treatment. More sensitive is a procedure of luminescence, using green indocyan. Determination of the affection degree of «sentinel lymph nodes» in gastric cancer may serve as an argument for change of the selection tactics while changing the tactics for the operative intervention volume choice.

Lymph node metastasis in gastric cancer: Location of positive station to predict survival after preoperative therapy.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 166-166
Author(s):  
Naruhiko Ikoma ◽  
Jeannelyn Estrella ◽  
Mariela A. Blum Murphy ◽  
Hsiang-Chun Chen ◽  
Xuemei Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Median Number ◽  
Preoperative Therapy ◽  
Preoperative Treatment ◽  
Node Dissection ◽  
D2 Lymph Node Dissection

166 Background: We sought to determine the association between the identification of positive lymph nodes on D2 lymph node dissection (LND) with stage and outcomes, in the era of preoperative treatment for gastric cancer. Methods: We reviewed data from a prospectively maintained database of gastric cancer patients who underwent resection of gastric or gastroesophageal cancer at our institution from 2005-2016. Central lymph nodes (CnLN) were defined as common hepatic, celiac, and proximal splenic artery lymph nodes (stations #8, 9, and 11p). Risk factors for CnLN metastases, and overall survival (OS) were examined. Results: We identified 356 patients, median age was 64 years (IQR 54-71) and 59% were male. Preoperative therapy was given in 66% of patients. D2 LND was performed in 80% of patients, and the median number of LN examined was 25 (IQR 18-34). Most patients (N = 244, 68%) had separately-examined CnLN in pathology and the median number of examined LNs was higher in this group (27 vs 19; p < 0.001). The CnLN positivity rate was 9.1% (22/244; #8: 4.8%, #9: 6.1%, and #11p: 4.8%), which was higher in advanced pT stage patients (pT0 - 3%, pT1 - 0%, pT2 - 6%, pT3 - 18%, pT4 - 13%; p = 0.001). If we assume that D2 LND was not performed on these patients, a total of 7 (3%, 7/244) patients would have had pN stage down-migration (6 with N1 to N0, 1 with N2 to N1). Of the 22 CnLN-positive patients, 10 (45%) had pN1, 2 (9%) had pN2, and 10 (45%) had pN3 stages. On multivariate analysis, EUS N stage (positive) was associated with positive CnLNs (OR 2.86 [95%CI 1.08-7.58]). Among 342 patients who had R0 resection, the median follow-up was 3.6 years, and the median OS was 11.6 years. Among patients who received preoperative therapy, pT3/4 stage (HR 2.44 [1.27-4.69]; p = 0.01) and positive CnLN (HR 5.44 [2.36-12.52]; p < 0.001) were negatively associated with OS by multivariate analysis. Conclusions: CnLN metastases are uncommon in gastric cancer, and are associated with an adverse impact on OS. However, long-term survival is still possible in patients with positive CnLN whom underwent a D2 lymph node dissection. Larger multi-institutional studies are needed to determine if CnLN positivity requires a separate staging category.

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