Lymph node mapping in gastric cancer: A pilot study in Western patients.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 192-192
Author(s):  
Akie Watanabe ◽  
Trevor D Hamilton
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Pilot Study ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Subtotal Gastrectomy ◽  
Median Number ◽  
Lymph Node Mapping ◽  
Indocyanine Green Fluorescence ◽  
Laparoscopic Subtotal Gastrectomy

192 Background: Adequate surgical lymphadenectomy is integral to the staging and treatment of gastric cancer. A number of Asian studies have explored the utility of lymph node (LN) mapping in gastric cancer but this in not commonly performed in Western countries. We sought to evaluate the utility and safety of LN mapping in Western patients. Methods: We conducted a pilot study of 13 patients with histologically proven non-metastatic gastric adenocarcinoma that received endoscopic peri-tumoral indocyanine green fluorescence (ICG) injections immediately prior to surgical resection to facilitate LN mapping. Illumination with ICG around the primary tumor, in lymphatic basins, tracts, and lymph nodes were confirmed by the PINPOINT system on recorded videos. Descriptive statistical analysis was performed. Results: Among the 13 patients enrolled, median age was 75 years and 7 were men. On pathologic review, 15% were T1, 54% were T2, and 69% had were node negative. Tumours were located in the proximal third in 1 patient, middle third in 2 patients and distal third in 10 patients. All patients had a laparoscopic subtotal gastrectomy and 10 patients had a D2 lymphadenectomy. 5 patients received preoperative and 7 received postoperative chemotherapy. The median number of LNs harvested was 26 [IQR 24-34]. Video confirmation of ICG mapping of the primary tumor, lymphatic basins, tracts, and LNs were obtained in all patients. All LNs identified with ICG uptake were removed with surgical lymphadenectomy. ICG mapped LNs fell outside the D1 distribution in 100% and outside the D1-plus distribution in 54% of cases. ICG mapped LNs were within the D2 distribution in all cases. No ICG related allergic reactions or procedural complications were observed. Postoperative complications included 2 grade A pancreatic fistulas, 1 gastrointestinal bleed, and 1 NSTEMI. Peri-operative morality was zero. Conclusions: We demonstrate ICG lymph node mapping as a safe and useful technique for identifying regional draining lymph nodes and for primary tumor localization in Western patients. The majority of cases found LNs draining outside the D1 and D1+ distributions, highlighting the importance of appropriate lymphadenectomies in gastric cancer.

scholarly journals A pilot study of lymph node mapping with indocyanine green in robotic gastrectomy for gastric cancer

2017 ◽  
Vol 5 ◽  
pp. 205031211772744 ◽  
Author(s):  
Yuan-Tzu Lan ◽  
Kuo-Hung Huang ◽  
Ping-Hsien Chen ◽  
Chien-An Liu ◽  
Su-Shun Lo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Pilot Study ◽  
Indocyanine Green ◽  
Robotic Gastrectomy ◽  
Lymph Node Mapping

scholarly journals Early results of laparoscopic subtotal gastrectomy for gastric cancer

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Vũ Tuấn Anh Nguyễn ◽  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Subtotal Gastrectomy ◽  
Operation Time ◽  
Viet Nam ◽  
Node Dissection ◽  
Average Hospital ◽  
D2 Lymph Node Dissection ◽  
Laparoscopic Subtotal Gastrectomy

Tóm tắt Đặt vấn đề: PTNS cắt bán phần dưới dạ dày điều trị ung thư biểu mô dạ dày đã dần được chấp nhận và áp dụng rộng rãi. Tuy nhiên, ngay cả với những phẫu thuật viên nhiều kinh nghiệm, PTNS cắt gần toàn bộ dạ dày điều trị ung thư biểu mô dạ dày, với phần dạ dày còn lại sau cắt rất nhỏ (10 – 20%), vẫn còn nhiều thử thách và nhiều tranh cãi, đặc biệt là khả năng nạo hạch hệ thống cũng như tái lập lưu thông sau cắt gần toàn bộ dạ dày. Tại Việt Nam, chưa có bất cứ nghiên cứu nào về phẫu thuật nội soi hoàn toàn cắt gần toàn bộ dạ dày nạo hạch tiêu chuẩn D2 điều trị ung thư biểu mô dạ dày, đặc biệt là cho nhóm ung thư biểu mô dạ dày vị trí 1/3 giữa. Phương pháp nghiên cứu: nghiên cứu tiến cứu, tại bệnh viện Đại học Y Dược TP HCM có 40 người bệnh (NB) ung thư biểu mô dạ dày được PTNS cắt gần toàn bộ dạ dày và nạo hạch tiêu chuẩn D2 trong khoảng thời gian từ tháng 1 năm 2018 đến tháng 5 năm 2019. Các dữ liệu lâm sàng và kết quả phẫu thuật được lượng giá. Kết quả: Thời gian phẫu thuật trung bình là 224,5 phút (từ 150 phút đến 360 phút), lượng máu mất trung bình là 25,6 ml (từ 10ml đến 200ml). Thời gian tái lập lưu thông trung bình là 32 phút (từ 15 phút đến 50 phút). Không có biến chứng trong mổ. Không có tử vong sau mổ. Biến chứng sau mổ gặp 2 trường hợp (5%): 1 tràn dịch màng phổi trái, và 1 nhiễm trùng vết mổ. Thời gian nằm viện trung bình là 7,8 ngày (từ 5 đến 14 ngày). Không có trường hợp nào xì miệng nối dạ dày hỗng tràng hoặc mỏm tá tràng. Kết luận: PTNS cắt gần toàn bộ dạ dày điều trị ung thư dạ dày nạo hạch tiêu chuẩn là an toàn, khả thi. Hơn nữa kỹ thuật này có thể thực hiện đối với ung thư dạ dày 1/3 giữa, thậm chí 1/3 trên, và có thể áp dụng thường qui. Abstract Background: Laparoscopic distal gastrectomy for adenocarcinoma has been accepted and worldwide applied. However, even experienced surgeons, laparoscopic subtotal gastrectomy for adenocarcinoma, remaining small part of stomach (10 – 20%) are still challenges and discussable issue among surgeons around the world, especially in lymph node dissection and reconstruction of intestinal tract. Nowadays in Viet Nam, no research about laparoscopic subtotal gastrectomy with standard D2 lymph node dissection for adenocarcinoma is available, especially the lesion is located in one third part of stomach. Materials and Method: This is a prospective study, conducted at the Pharmacy and Medicine University in Ho Chi Minh city. 40 patients underwent the laparoscopic subtotal gastrectomy associated with the standard lymph node dissection from Jan 2018 to May 2019 enrolled. The clinical database and surgical outcomes were assessed and quantified. Results: The average operation time was 224,5 minutes ( from 150 to 360 minutes), average blood loss is 25,6 ml (range, 10 to 90ml), average anastomosis time is 32 minutes (range, 15 to 50 minutes). No complications were observed during surgery. There were no deaths, and post-operative morbidity were two cases, accounted for 5%: one pleural effusion, and one surgical site infection. The average hospital length stay was 7,8 days ( from 5 to 14 days). No leakage of gastrojejunostomy or duodenal stump fistula. Conclusions: Laparoscopic subtotal gastrectomy with standard D2 lymph node dissection for gastric cancer is safe, feasible. Additionally, it is also reliable gastric cancers located in middle third, and even upper third of stomach, and could be routinely applied. Key words: Gastric cancer, laparoscopic surgery, subtotal gastrectomy.

scholarly journals Quantifying the number of lymph nodes for examination in breast cancer

2019 ◽  
Vol 48 (2) ◽  
pp. 030006051987959
Author(s):  
Liping Sun ◽  
Ping Li ◽  
He Ren ◽  
Gang Liu ◽  
Lining Sun
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Tumor Stage ◽  
Median Number ◽  
Binomial Model ◽  
Nodal Staging ◽  
Breast Cancer Invasion ◽  
Positive Lymph Nodes

Objective Examining the correct number of lymph nodes when diagnosing breast cancer invasion is still a problem. This work aimed to develop a qualification model that estimates the possibility of missing nodes and the number of lymph nodes that need to be examined. Methods By analyzing lymph node invasion of 303,760 breast cancer samples with primary tumor stage and the number of examined and positive lymph nodes from the Surveillance, Epidemiology and End Results database using a beta-binomial model, the number of nodes that should be examined was quantified in different stages. Results In general, to reduce the possibility of missing positive nodes to less than 10%, 21 lymph nodes should be examined; thus, the current median of dissected nodes (12) is not adequate. The number of nodes needed to be dissected for stages T1, T2, and T3 are 8, 37, and 87, respectively. Currently, the median number of node dissections for these stages were 12, 13, and 14, respectively. The clinical significance of the nodal staging score was validated with survival information. Conclusion Currently, the number of lymph nodes dissected in breast cancer are excessive for T1 but insufficient for T2 and T3.

scholarly journals A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis Treated with Preoperative FOLFOX Chemotherapy Followed by Radical Subtotal Gastrectomy and D2 Lymph Node Dissection

2017 ◽  
Vol 10 (1) ◽  
pp. 182-191 ◽  
Author(s):  
Byoung Jo Suh
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Fdg Pet ◽  
Subtotal Gastrectomy ◽  
Pet Ct ◽  
Node Metastases ◽  
Folfox Chemotherapy ◽  
Fdg Pet Ct

We report the case of a 73-year-old female who was diagnosed with advanced gastric cancer. Esophagogastroduodenoscopy was used to diagnose Borrmann type 3 advanced gastric cancer located at the gastric antrum. A biopsy revealed poorly differentiated adenocarcinoma. Abdominopelvic computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography-CT (FDG-PET-CT) scans demonstrated multiple lymph node metastases, including the para-aortic lymph nodes. Systemic chemotherapy with 5-fluoruracil (5-FU), oxaliplatin, and leucovorin (FOLFOX) was initiated. An abdominopelvic CT scan taken after 4 cycles of chemotherapy showed improvement in the ulceroinfiltrative gastric lesion and marked regression of several enlarged lymph nodes. Consequently, we performed a subtotal gastrectomy with D2 lymphadenectomy. The postoperative histopathological report was early gastric carcinoma with no lymph node metastasis in the 48 resected lymph nodes. Another 4 cycles of FOLFOX chemotherapy were performed after surgery. A FDG-PET-CT scan taken 12 months postoperatively showed no definite evidence of local recurrence or distant metastasis, and the previously noted retroperitoneal lymph nodes had disappeared. A FDG-PET-CT taken 16 months postoperatively showed multiple lymph node metastases, including the left supraclavicular lymph node. Despite 8 cycles of secondary chemotherapy with 5-FU, irinotecan, and leucovorin (FOLFIRI) and radiotherapy, the patient died 38 months after the operation.

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.

scholarly journals Sentinel Lymph Node Mapping In Gastric Cancer Surgery: Current Status

2016 ◽  
Vol 62 (4) ◽  
pp. 403-407 ◽  
Author(s):  
Tivadar Bara ◽  
Tivadar Bara ◽  
Radu Neagoe ◽  
Daniela Sala ◽  
Simona Gurzu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Gastric Cancer ◽  
Lymph Nodes ◽  
Sentinel Lymph Node Mapping ◽  
Sentinel Lymph Nodes ◽  
Current Status ◽  
Lymph Node Mapping ◽  
Invasion Stage

AbstractLymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion. The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.

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

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.

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

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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