A Study on Lymph Nodes Metastases Along the Splenic Artery of Gastric Cancer.

Aim. To study lymphatic metastasis of proximal gastric cancer to determine the extent of surgical intervention both on the stomach wall and lymphatic pathways. Methods. The data on lymphatic metastasis were analyzed in 185 patients with proximal gastric cancer not extending to the esophagus who underwent gastrosplenectomy with extended lymphodissection D2 in 2 surgical departments of the Republican clinical oncology center (Kazan) in 1982-2014. All patients were morphologically verified prior to surgery. 105 out of 185 patients (56.7%) had metastases to lymph nodes. Results. In proximal gastric cancer (within IV and V angiological segments) lymph node involvement in cancer metastases occurs in all sub-segments of the lymphatic system of the stomach. There is a fairly clear pattern: involvement of lymph nodes in metastases mainly occurs in groups №3a, 3b, and 4d, along the common hepatic artery and its branches, around the celiac trunk, along the splenic artery and in splenic hilum. In case of cancer localization in segment IV metastases were observed in 46.7%, in segment V - in 66.7% and in case of involvement of both segments IV and V - in 53.3% of patients. In gastric cancer located within segments IV and V, starting with the involvement of muscular tunic, lymph nodes of perigastric groups (№3b - in 37.1%, 4d - in 11.4%) are often affected as well as parietal lymph nodes of groups 7-12. Conclusion. In cancer located within gastric segments IV and V gastrosplenectomy with extended lymphodissection D2 should be performed to remove lymph node groups along the splenic artery and in splenic hilum.

Download Full-text

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

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.359 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 359-359

Author(s):

Tsutomu Hayashi ◽

Takaki Yoshikawa ◽

Ayako Kamiya ◽

Keichi Date ◽

Takeyuki Wada ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Survival Benefit ◽

Splenic Artery ◽

Cancer Center ◽

High Morbidity ◽

Gastric Artery ◽

Regional Lymph Nodes ◽

Metastatic Rate ◽

The Right

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.

Download Full-text

861: Lymph Nodes Metastases in Patients with Prostate Cancer and with a PSA < 10NG/ML

The Journal of Urology ◽

10.1016/s0022-5347(18)38110-2 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 228-228

Author(s):

Martin Schumacher ◽

Fiona C. Burkhard ◽

Regula Markwalder ◽

Urs E. Studer

Keyword(s):

Prostate Cancer ◽

Lymph Nodes ◽

Lymph Nodes Metastases

Download Full-text

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

Download Full-text

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.

Download Full-text

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

Download Full-text

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.

Download Full-text

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.

Download Full-text