scholarly journals Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis

2022 ◽  
Vol 11 ◽  
Author(s):  
Shinichi Kinami ◽  
Hitoshi Saito ◽  
Hiroyuki Takamura
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Node Metastasis ◽  
Node Biopsy

The stomach exhibits abundant lymphatic flow, and metastasis to lymph nodes is common. In the case of gastric cancer, there is a regularity to the spread of lymph node metastasis, and it does not easily metastasize outside the regional nodes. Furthermore, when its extent is limited, nodal metastasis of gastric cancer can be cured by appropriate lymph node dissection. Therefore, identifying and determining the extent of lymph node metastasis is important for ensuring accurate diagnosis and appropriate surgical treatment in patients with gastric cancer. However, precise detection of lymph node metastasis remains difficult. Most nodal metastases in gastric cancer are microscopic metastases, which often occur in small-sized lymph nodes, and are thus difficult to diagnose both preoperatively and intraoperatively. Preoperative nodal diagnoses are mainly made using computed tomography, although the specificity of this method is low because it is mainly based on the size of the lymph node. Furthermore, peripheral nodal metastases cannot be palpated intraoperatively, nodal harvesting of resected specimens remains difficult, and the number of lymph nodes detected vary greatly depending on the skill of the technician. Based on these findings, gastrectomy with prophylactic lymph node dissection is considered the standard surgical procedure for gastric cancer. In contrast, several groups have examined the value of sentinel node biopsy for accurately evaluating nodal metastasis in patients with early gastric cancer, reporting high sensitivity and accuracy. Sentinel node biopsy is also important for individualizing and optimizing the extent of uniform prophylactic lymph node dissection and determining whether patients are indicated for function-preserving curative gastrectomy, which is superior in preventing post-gastrectomy symptoms and maintaining dietary habits. Notably, advancements in surgical treatment for early gastric cancer are expected to result in individualized surgical strategies with sentinel node biopsy. Chemotherapy for advanced gastric cancer has also progressed, and conversion gastrectomy can now be performed after downstaging, even in cases previously regarded as inoperable. In this review, we discuss the importance of determining lymph node metastasis in the treatment of gastric cancer, the associated difficulties, and the need to investigate strategies that can improve the diagnosis of lymph node metastasis.

scholarly journals Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy

2003 ◽  
Vol 29 (4) ◽  
pp. 341-350 ◽  
Author(s):  
M.P. Schijven ◽  
A.J.J.M. Vingerhoets ◽  
H.J.T. Rutten ◽  
G.A.P. Nieuwenhuijzen ◽  
R.M.H. Roumen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Node Biopsy

How many lymph nodes may serve as a guideline for a sufficient extended lymph node dissection during radical prostatectomy?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16102-e16102
Author(s):  
G. Pomara ◽  
G. Campo ◽  
C. Milesi ◽  
P. Casale ◽  
F. Francesca
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Median Number ◽  
Node Dissection ◽  
Extended Lymph Node Dissection ◽  
Experienced Surgeon ◽  
Node Metastasis ◽  
Positive Lymph Nodes

e16102 Background: Recent data suggest that extended lymph node (LN) dissection at radical prostatectomy (RP) may be necessary to detect occult positive lymph nodes, and that extended dissection may also have a positive impact on disease progression and long-term disease-free survival. However, evaluation of lymphadenectomy to be complete and sufficient as judged by the number of removed lymph nodes is sometimes difficult. Some authors reported that approximately 20 pelvic lymph nodes may serve as a guideline for a sufficient extended lymph node dissection during RP. The purposes of this study were 1) to assess the reproducibility of this number (20 LN) in experienced hands; 2) to evaluate the effect of the number of LNs removed on lymph node metastasis. Materials and Methods: Data from 293 consecutives patients undergone to RP with extended lymphadenectomy were prospectively analyzed [median age 66 (35–79), median PSA 7.98 ng/ml (2.5–35)]. The number of lymph nodes extracted and the number of patients with positive lymph nodes detected were analyzed and compared. Moreover we distinguished and analyzed RPs data of most experienced surgeon: 124 patients [median age 65aa (44–79), median PSA 6.7(2.5–19)]. Results: Analyzing all the population, the median number of removed lymph nodes was 15 (1–39). Analyzing only the most experienced surgeon results, the median number of removed lymph nodes was 20 (range 6–39). The effect of the number of LNs removed on lymph node metastasis is shown in the Table . Conclusions: Compared to limited lymph node dissection (< 10 removed LNs), extended pelvic lymphadenectomy appears to identify men with positive lymph nodes more frequently. Although very experienced surgeons remove approximately 20 pelvic lymph nodes (comparable to the literature), our results seem to underline that 15 removed LNs are sufficient as a guideline for an extended lymph node dissection during RP. [Table: see text] No significant financial relationships to disclose.

scholarly journals Report about the clinical meaning of patients with pathologic metastasis of lateral lymph nodes but no metastasis of mesenteric lymph nodes after lateral lymph node dissection in low rectal cancer

2020 ◽  
Author(s):  
Peng Li ◽  
Zhichun Zhang ◽  
Yuanda Zhou ◽  
Qingsheng Zeng ◽  
Xipeng Zhang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Low Rectal Cancer ◽  
Node Dissection ◽  
Lateral Lymph Node ◽  
Node Metastasis ◽  
Mesenteric Lymph

Abstract Purpose The aim of this study is to investigate the clinical significance of lateral lymph node metastasis with no mesenteric lymph node metastasis after lateral lymph node dissection in middle and low rectal cancer .Methods Retrospective analysis was performed on the clinical data of 5 consecutive patients who were pathologically diagnosed with lateral lymph node metastasis, while mesenteric lymph node metastasis was not observed after laparoscopic lateral lymph node dissection underwent for advanced low rectal cancer from July 2017 to August 2019.Results All the 5 patients were successfully completed laparoscopic lateral lymph node dissection, and no cases were transferred to laparotomy.The mean age was 58.80±6.53 years, Two Miles surgeries and three Dixson surgeries were performed.Conclusion We found that some patients had lateral lymph node metastasis, while mesenteric lymph nodes had no metastasis after lateral lymph node dissection.This phenomenon suggests that lateral lymph nodes are one of the important metastasis pathways of low rectal cancer,a new N stage is needed to distinguish it from other types of lymph node metastasis.In addition, LLND is of great significance for the pathological diagnosis of lateral lymph nodes.

Sentinel node biopsy versus elective lymph node dissection in patients with cutaneous melanoma in a Japanese population

2007 ◽  
Vol 12 (4) ◽  
pp. 245-249 ◽  
Author(s):  
Arata Tsutsumida ◽  
Hiroshi Furukawa ◽  
Yuhei Yamamoto ◽  
Katsumi Horiuchi ◽  
Tetsunori Yoshida ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Lymph Node Dissection ◽  
Cutaneous Melanoma ◽  
Japanese Population ◽  
Node Dissection ◽  
Elective Lymph Node Dissection ◽  
Node Biopsy

PS01.124: AN OPTIMAL SURGICAL APPROACH AND THE EXTENT OF LYMPH NODE DISSECTION FOR BARRETT’S ADENOCARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 85-85
Author(s):  
Yusuke Gokon ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Chiaki Sato ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Surgical Approach ◽  
Proximal Gastrectomy ◽  
Complete Resection ◽  
Node Dissection ◽  
Node Metastasis ◽  
Barrett’S Adenocarcinoma

Abstract Background An optimal surgical approach and the extent of lymph node dissection for Barrett's adenocarcinoma remain controversial. The standard surgical approach for Barrett's adenocarcinoma at our institution is performing thoracoscopic esophagectomy. Proximal gastrectomy is preferred in cases where distance between the proximal edge of the primary tumor and the esophagogastric junction is < 3 cm. However, some studies suggest a complete resection of Barrett's esophagus. Methods The clinicopathologic data of 36 patients with Barrett's adenocarcinoma who were admitted to our institution between 1994 and 2017 were retrospectively analyzed to assess the efficacy of lymph node dissection at each station using the index of estimated benefit from lymph node dissection (IEBLD). Results The tumor locations were found to be the middle thoracic, lower thoracic, and abdominal esophagus in 2 (5.6%), 17 (47.2%), and 17 (47.2%) cases, respectively. A total of 28 (77.8%), 6 (16.7%), and 2 (5.5%) patients underwent esophagectomy, proximal gastrectomy, and transhiatal esophagectomy, respectively. The overall lymph node metastasis rate was 41.6%. The IEBLD indexes of the middle/lower thoracic lymph and the abdominal lymph nodes were comparable, whereas those of the paraesophageal lymph nodes (#108 and 110) were relatively high. Conversely, the metastasis rates of the upper thoracic lymph nodes were 13.9%, with no IEBLD values. Cervical lymph node metastasis was not identified, and the significance of dissection was unclear. Stratified by the location of tumor, the ILBLD index of middle/lower thoracic lymph node was relatively high in Lt cases. Conversely, those of abdominal lymph nodes were high and those of middle thoracic lymph nodes were not identified in Ae cases. In proximal gastrectomy cases, the complete resection of Barrett's esophagus was not achieved in 2 (40%) cases with LSBE. Lymph node metastasis was identified in one case (#110). The recurrence-free survival rate was 100%. Conclusion The significance of upper thoracic lymph node dissection was unclear, whereas those of middle/lower thoracic lymph and the abdominal lymph nodes were comparable. The selection of an appropriate surgical approach at our institution was acceptable. The efficacy of complete resection of LSBE was not observed. Disclosure All authors have declared no conflicts of interest.

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