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

359 Background: Splenectomy for dissecting splenic hilar nodes (#10) should be avoided for most gastric cancer considering high morbidity and no survival benefit, while that is often selected in scirrhous type of gastric cancer because this special type frequently invades the whole stomach and the #10 nodes. Splenectomy is necessary for dissecting #10, however, survival benefit of dissecting #10 is unclear. Methods: Patients who had scirrhous gastric cancer and underwent D2 total gastrectomy with splenectomy in National Cancer Center Hospital, Japan, between 2000 to 2011 were retrospectively analyzed. The therapeutic value index was calculated by multiplying the metastatic rate of each nodal station and the 5-year survival of patients who had metastasis to each node. Results: In total, 144 patients were eligible for the present study. The most frequent metastatic site was the nodes along the lessar curvature (#3, 57%), followed by the nodes along the right gastro-epiploic artery (#4d, 45%), the right nodes located at the cardia (#1, 34%), the nodes along the left gastro-epiploic artery (#4sb, 23%), the inferior nodes at the pyloric ring (#6, 22%), the nodes along the left gastric artery (#7, 21%), the nodes along the short gastric artery (#4sa, 18%), the nodes along the cardiac branched artery (#2, 15%), the nodes around the spleen (#10, 15%), the distal nodes along the splenic artery (#11d, 15%), the proximal nodes along the splenic artery (#11p, 13%), the nodes around the celiac artery (#9, 13%), and the nodes along the common hepatic artery (#8a, 10%). These lymph nodes had a metastatic rate of more than 10%. The node with the highest index was #3(18), followed by #4d(13.4), #1(9.59), #4sa(5.85), #4sb(5.75), #10(4.86), #7(4.16), #11d(4.16), #11p(3.87), #2(3.07), #8a(2.08), and #9(1.39). The index of #10 was exceeded that of #2, #7, #8a, and #9 which are the key nodes dissected in D2. Conclusions: The metastatic rate of splenic hilar nodes was relatively high, and the therapeutic index was the sixth highest in the fifteen regional lymph nodes included in D2 dissection. Splenectomy for dissecting splenic hilar nodes would be justified in scirrhous type of gastric cancer considering its survival benefit.

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Clinical significance of lymphatic flows around pylorus identified by sentinel node mapping in patients with gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.12 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 12-12

Author(s):

Junya Aoyama ◽

Hirofumi Kawakubo ◽

Shuhei Mayanagi ◽

Kazumasa Fukuda ◽

Koichi Suda ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Sentinel Node ◽

Left Gastric Artery ◽

Gastroepiploic Artery ◽

Colloid Solution ◽

Blue Dye ◽

Gastric Artery ◽

The Right ◽

Posterior Gastric Artery

12 Background: The sentinel node (SN) concept is safely applied and validated in early gastric cancer. Gastric lymph nodes are divided into five basins with the main gastric arteries. The suprapyloric lymph nodes (No. 5) and the anterosuperior lymph nodes with the common hepatic artery (No. 8a) are classified in the right gastric artery (r-GA) basin, and the subpyloric lymph nodes (No. 6) are classified in the right gastroepiploic artery (r-GEA) basin. The aim of this study is to analyze the lymphatic flows between these lymph nodes and basins. Methods: Five hundred and fourty-nine patients with cT1N0 or cT2N0 gastric cancer underwent SN mapping. We used technetium-99 tin colloid solution and blue dye as a tracer. Results: We detected SN No. 5 in 36 (6.6 %) patients. In these patients, we detected SN No. 5 with SNs that belonged to the left gastric artery (l-GA) basin (69 %), r-GA basin (14 %), and r-GEA basin (44 %). No. 6 was detected as SN significantly more frequently with SN No. 5. We detected SN No. 6 in 100 (18.2 %) patients. In these patients, we detected SN No. 6 with SNs that belonged to the l-GA basin (42 %), left gastroepiploic artery (l-GEA) basin (4 %), r-GA basin (28 %), and r-GEA basin (41 %). No. 4d, No. 5 and No. 8a were detected as SNs significantly more frequently with SN No. 6. We detected SN No. 8a in 43 (7.8 %) patients. In these patients, we detected SN No. 8a with SNs that belonged to the l-GA basin (65 %), l-GEA basin (7 %), r-GA basin (21 %), r-GEA basin (58 %), and posterior gastric artery (p-GA) basin (7 %). No. 6 and No. 9 were detected as SNs significantly more frequently with SN No. 8a. SN No. 5 and No. 8a were tend to be detected with not SNs that belonged to the r-GA basin but No. 6, and SN No. 6 was detected significantly more frequently with No. 4d, No. 5 and No. 8a. Conclusions: Our findings show that lymphatic flows exist not only between lymph nodes which are belonged to the same basin, but also between No. 5 and No.6, and No.6 and No. 8a. On the other hand, the lymphatic flows between No. 5 and No. 8a seem to be limited. Our results suggest that the lymph node dissection of No. 6 given lymphatic flows from lesser curvature side and retroperitoneal side is important for surgery of gastric cancer.

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Morbidity associated to advanced gastric cancer and its impact on overall survival.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.327 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 327-327

Author(s):

Mónica Isabel Meneses Medina ◽

Ana Karen Valenzuela ◽

Jorge Humberto Hernandez-Felix ◽

Haydee Cristina Verduzco-Aguirre ◽

Vanessa Rosas Camargo ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Advanced Gastric Cancer ◽

Univariate Analysis ◽

Rank Test ◽

P Value ◽

High Morbidity ◽

Regional Lymph Nodes ◽

Oncological Treatment ◽

Kaplan Meier

327 Background: Advanced gastric cancer (GC) is a disease with high morbidity and poor prognosis. We hypothesize that different sites of metastasis have different impact in terms of symptoms and complications. We sought to evaluate if site specific morbidity in our patients impacted treatment and survival. Methods: Medical records from patients with advanced GC treated from Jan 2005 to Dec 2015 were retrospectively reviewed. Morbidity was defined as having any symptom by metastases in a specific site. OS was estimated by Kaplan Meier method and compared by Log-rank test. P value < 0.05 was considered significant. Results: We included 180 consecutive patients, median age at diagnosis was 56 years (21-90), 55% were women. Most common sites of metastases were: peritoneum 76.1%, non-regional lymph nodes 38.9%, liver 22.8%, lung 26.7%, bone 9.4% and ovary 12.8%. Regarding morbidity, at diagnosis 68% of patients presented morbidity by the primary tumor: obstruction 56%, bleeding 27%, obstruction and bleeding 3%, other 14%. Disease by peritoneum caused morbidity in 30%, by lung in 8%, by ovarian in 4.4%, by lymph nodes in 3.3%, and by other sites in 5.6% of patients. OS in the global cohort was: 3.53 months (2.2 to 4.8), nevertheless by univariate analysis we found that OS was affected by morbidity at some sites as it is show in table. More patients with peritoneal morbidity could not receive treatment vs those without peritoneal morbidity (p = 0.042). Conclusions: We found that morbidity in peritoneum, lung and ovary adversely affected prognosis of patients with advanced GC. Moreover, peritoneal morbidity preclude patients from receiving oncological treatment. [Table: see text]

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A case of primary biliary cirrhosis with sarcoid reaction in the regional lymph nodes after surgery of early gastric cancer

Kanzo ◽

10.2957/kanzo.46.437 ◽

2005 ◽

Vol 46 (7) ◽

pp. 437-442 ◽

Cited By ~ 2

Author(s):

Tadashi YOSHIDA ◽

Atsushi NAGASAKA ◽

Yayoi OGAWA ◽

Syuji NISHIKAWA ◽

Akifumi HIGUCHI

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Primary Biliary Cirrhosis ◽

Lymph Nodes ◽

Biliary Cirrhosis ◽

Regional Lymph Nodes ◽

Sarcoid Reaction

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BIOPSY OF THE SIGNALING LYMPH NODES IN GASTRIC CANCER - CURRENT STATUS OF THE PROBLEM AND PROSPECTS

Problems in oncology ◽

10.37469/0507-3758-2018-64-3-335-344 ◽

2018 ◽

Vol 64 (3) ◽

pp. 335-344

Author(s):

Aleksey Karachun ◽

Yuriy Pelipas ◽

Oleg Tkachenko ◽

D. Asadchaya

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Stomach Cancer ◽

Current Status ◽

Regional Lymph Nodes ◽

Systematic Analysis ◽

Tumor Spread ◽

Special Value

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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Multiple early gastric cancer associated with sarcoid-like reaction in the regional lymph nodes

Journal of Gastroenterology ◽

10.1007/s005350170036 ◽

2001 ◽

Vol 36 (10) ◽

pp. 710-717 ◽

Cited By ~ 9

Author(s):

Masayuki Nakamura ◽

Eishi Mizuta ◽

Hideshi Morioka ◽

Mitsuo Nakamura ◽

Kimio Isiglo

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Lymph Nodes ◽

Regional Lymph Nodes

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Two Cases of Early Gastric Cancer with Sarcoid Reaction in the Regional Lymph Nodes.

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.25.2520 ◽

1992 ◽

Vol 25 (10) ◽

pp. 2520-2524 ◽

Cited By ~ 2

Author(s):

Hajime Abe ◽

Nobukuni Terata ◽

Hisanori Shiomi ◽

Hiroyuki Naito ◽

Junsuke Shibata ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Lymph Nodes ◽

Regional Lymph Nodes ◽

Sarcoid Reaction

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Laparoscopic infrapyloric lymph nodes dissection through the right bursa omentalis approach for gastric cancer

BMC Surgery ◽

10.1186/s12893-021-01192-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kun Yang ◽

Wei-Han Zhang ◽

Kai Liu ◽

Xin-Zu Chen ◽

Xiao-Long Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Laparoscopic Gastrectomy ◽

Operation Time ◽

D2 Lymphadenectomy ◽

Estimated Blood Loss ◽

Bursa Omentalis ◽

The Mean ◽

Infrapyloric Lymph Nodes ◽

The Right

Abstract Background A complete dissection of infrapyloric lymph nodes is the key to a curative gastrectomy, which can be sometimes technically challenging in laparoscopic surgery. Methods One hundred and eighteen patients with gastric cancer undergoing laparoscopic gastrectomy with D2 lymphadenectomy in which the infrapyloric lymph nodes were dissected through the right bursa omentalis approach were included. The clinicopathologic characteristics and surgical outcomes were analyzed retrospectively. Results The laparoscopic gastrectomy with D2 lymphadenectomy was successful in all 118 patients with no open conversion. The mean operation time was 246.6 ± 45.7 min. The mean estimated blood loss was 87.0 ± 35.9 mL. Postoperative complications occurred in 17.8% of the patients, which were treated successfully with conservative therapy or aspiration in all. There were no No.6 lymphadenectomy-associated complications, such as injury of transverse colon, vessels of mesocolon, pancreas or duodenum, no pancreatitis, pancreatic leakage or postoperative hemorrhage. The mean postoperative hospital stay was 9.6 ± 3.7 days. On average, the total lymph nodes harvested were 36.8 ± 12.9, in which the ones from the infrapyloric area were 5.1 ± 3.1. Conclusion Laparoscopic dissection of infrapyloric lymph nodes through the right bursa omentalis approach seems to be feasible and safe, facilitating a more complete No.6 lymphadenectomy for gastric cancer.

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