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1
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Hayashi T, Yoshikawa T, Ishizu K, Tsutsui M, Wada T, Yamagata Y, Katai H. Suprapancreatic nodal dissection should not be uniformly selected in additional gastrectomy for the patients who diagnosed as pT1b gastric cancer by endoscopic resection. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1785-1789. [DOI: 10.1016/j.ejso.2022.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 01/09/2022] [Accepted: 01/30/2022] [Indexed: 02/07/2023]
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2
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Tanishima Y, Nishikawa K, Matsumoto A, Yuda M, Tanaka Y, Yano F, Mitsumori N, Yanaga K. Comparison of laparoscopic surgery and hand-assisted laparoscopic surgery in esophagectomy: A propensity score-matched analysis. Asian J Endosc Surg 2021; 14:21-27. [PMID: 32633049 DOI: 10.1111/ases.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Laparoscopic surgery (LAP) and hand-assisted laparoscopic surgery (HALS) for mobilization of the stomach and abdominal lymph node dissection in esophagectomy have become standard procedures in Japan. However, the differences in outcomes between LAP and HALS have not been examined. We aimed to compare the safety and feasibility of these techniques in patients undergoing esophagectomy. METHODS We assessed 171 patients who underwent esophagectomy and reconstruction for clinical stage 0 to IVa esophageal cancer; 108 patients were treated with HALS and 63 with LAP. Mortality, morbidity, and long-term survival were compared in all patients who had undergone these surgical procedures and then in 59 propensity score-matched pairs to correct for differences in baseline characteristics. RESULTS In our analysis, HALS had a shorter abdominal operative time (84.4 ± 26.6 vs 110.0 ± 34.1 minutes, P < .0001), but LAP enabled a larger number of abdominal lymph nodes to be harvested with (17.9 ± 6.6 vs 15.4 ± 7.4, P = .0486). The 5-year overall survival rates were 62.1% and 74.5% (P = .1257) for patients who had undergone HALS and LAP, respectively, and the relapse-free survival rates were 67.0% and 72.3% (P = .7243). CONCLUSIONS There were no significant differences in postoperative mortality and morbidity between the two groups. This suggests that in addition to having a short operative time, HALS has good technical feasibility and is oncologically safe for patients with esophageal cancer.
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Affiliation(s)
- Yuichiro Tanishima
- Division of Gastroenterological Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Katsunori Nishikawa
- Division of Gastroenterological Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Matsumoto
- Division of Gastroenterological Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Masami Yuda
- Division of Gastroenterological Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yujiro Tanaka
- Division of Gastroenterological Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumiaki Yano
- Division of Gastroenterological Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Norio Mitsumori
- Division of Gastroenterological Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhiko Yanaga
- Division of Gastroenterological Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Lianos GD, Bali CD, Hasemaki N, Glantzounis GK, Mitsis M, Rausei S. Sentinel Node Navigation in Gastric Cancer: Where Do We Stand? J Gastrointest Cancer 2019; 50:201-206. [PMID: 30815770 DOI: 10.1007/s12029-019-00217-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early gastric cancer (EGC) is more common nowadays and is related a to low percentage of lymph node metastasis. For this reason, there is enormous interest to implicate minimally invasive approaches. Recently, special efforts have been made towards a potential intraoperative (real-time) lymph node metastasis (LNM) assessment, as nodal disease status could not be identified with precision before or during surgery. In this direction, accurate prediction of the LNM status through sentinel LN mapping has been attempted, as an approach to the intraoperative detection of sentinel lymph nodes (SLNs). A careful literature search was conducted in order to clarify the potential clinical application of SN biopsy in the gastric cancer field. CONCLUSION The real clinical application of SN biopsy in gastric cancer treatment has been more than challenging due to the "complicated" nature of gastric lymphatic drainage and the high possibility of "skip" metastasis phenomenon. Notably, sophisticated technical aspects, such as the preferred tracer used and the potential "ideal" method to verify the presence of metastases in the resected SLNs, made SN biopsy application in gastric cancer field extremely demanding. Assessing the potential role of SN navigation for gastric cancer treatment in the era of advanced technology, where the minimally invasive surgical approaches are in the top of the scientific interest, it has to be highlighted that SN navigation for gastric cancer is a topic that remains highly controversial, and the need for future clinical trials on this topic is obvious.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, 45110, Ioannina, Greece.
| | - Christina D Bali
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Natasha Hasemaki
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios K Glantzounis
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
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4
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Liu JY, Deng JY, Zhang NN, Liu HF, Sun WL, He WT, Wang Y, Zhang L, Liang H. Clinical significance of skip lymph-node metastasis in pN1 gastric-cancer patients after curative surgery. Gastroenterol Rep (Oxf) 2019; 7:193-198. [PMID: 31217983 PMCID: PMC6573797 DOI: 10.1093/gastro/goz008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/30/2018] [Accepted: 01/10/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In addition to the stepwise manner of lymph-node metastasis from the primary tumour, the skip lymph-node metastasis (SLNM) was identified as a low-incidence metastasis of gastric cancer (GC). So far, both the mechanism and outcome of SLNM have not been elucidated completely. The purpose of this study was to analyse the clinical significance and the potential mechanism of SLNM in GC patients who had lymph-node metastasis. METHODS Clinicopathological data and follow-up information of 505 GC patients who had lymph-node metastasis were analysed to demonstrate the significance of SLNM in evaluating the prognostic outcome. According to the pathological results, all GC patients who had lymph-node metastasis were categorized into three groups: patients with the perigastric lymph-node metastasis, patients with the perigastric and extragastric lymph-node metastasis and patients with SLNM.Results: Among the 505 GC patients who had lymph-node metastasis, 24 (4.8%) had pathologically identified SLNM. The location of lymph-node metastasis was not significantly associated with 5-year survival rate and overall survival (OS) (P = 0.194). The stratified survival analysis results showed that the status of SLNM was significantly associated with the OS in patients with pN1 GC (P = 0.001). The median OS was significantly shorter in 19 pN1 GC patients with SLNM than in 100 patients with perigastric lymph-node metastasis (P < 0.001). The case-control matched logistic regression analysis results showed that tumour size (P = 0.002) was the only clinicopathological factor that may predict SLNM in pN1 GC patients undergoing curative surgery. Among the 19 pN1 GC patients with SLNM, 17 (89.5%) had metastatic lymph nodes along the common hepatic artery, around the celiac artery or in the hepatoduodenal ligament. CONCLUSIONS SLNM may be considered a potentially practicable indicator for prognosis among various subgroups of pN1 GC patients.
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Affiliation(s)
- Jin-Yuan Liu
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, P. R. China
- Department of General Surgery, The Affiliated Hospital of Nankai University, Tianjin, P. R. China
| | - Jing-Yu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Nan-Nan Zhang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Hui-Fang Liu
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Wei-Lin Sun
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Wen-Ting He
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Yan Wang
- Department of General Surgery, The Affiliated Hospital of Nankai University, Tianjin, P. R. China
| | - Li Zhang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Han Liang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, P. R. China
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5
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Arroyo-Martinez Q, Han WH, Eom BW, Yoon HM, Kim YI, Cho SJ, Lee JY, Kim CG, Morales-Conde S, Padillo-Ruiz J, Kook MC, Choi IJ, Kim YW, Ryu KW. The distribution pattern of metastatic lymph nodes after non-curative endoscopic resection in early gastric cancer. J Surg Oncol 2018; 118:1257-1263. [PMID: 30367687 DOI: 10.1002/jso.25279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Additional surgery should be done after non-curative endoscopic resection (ER) in early gastric cancer (EGC) due to the risk of lymph node metastasis (LNM). However, the distribution pattern of LNM in these patients is complicated and unpredictable. The aim of this study is to identify any different distribution patterns of LNM in patients with EGC who underwent additional surgery after non-curative (ER) comparing to those without ER. METHODS Patients who underwent surgery for EGC between 2001 and 2016 were included. Enrolled patients were divided into two groups, those who underwent additional surgery after non-curative ER and those who underwent direct surgery without a history of ER. Demographics, tumor characteristics and LNM distribution pattern were analyzed. RESULTS Among 4295 patients with EGC, 404 patients had a history of preoperative ER, and 3891 patients did not. After the application of exclusion criteria, 23 (7.1%) of 322 patients undergoing additional surgery had LNM. The additional surgery group showed less LNM, fewer nodal stations and more restricted distribution pattern of LNM. CONCLUSIONS The distribution pattern of LNM in EGC is complicated. However, more restricted locoregional LNM could be expected in cases of additional surgery after non-curative ER than after direct surgery.
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Affiliation(s)
- Quetzalihuitl Arroyo-Martinez
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea.,Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Seville, Spain
| | - Won Ho Han
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Young Il Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Soo Jeong Cho
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Salvador Morales-Conde
- Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Seville, Spain
| | - Javier Padillo-Ruiz
- Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Seville, Spain
| | - Myeong-Cherl Kook
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Young Woo Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
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Mpallas KD, Lagopoulos VI, Kamparoudis AG. Prognostic Significance of Solitary Lymphnode Metastasis and Micrometastasis in Gastric Cancer. Front Surg 2018; 5:63. [PMID: 30406109 PMCID: PMC6200848 DOI: 10.3389/fsurg.2018.00063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 09/21/2018] [Indexed: 12/14/2022] Open
Abstract
Gastric cancer (GC) used to be one of the most common malignancies in the world and still is the second leading cause of malignancy-related death in the Far East. The most significant factors that were found to be associated with the clinical outcome in patients with non-metastatic (M0) gastric cancer is tumor's depth of invasion, the presence and the extend of lymphnode involvement, as well as the histological type according to Lauren (intestinal or diffuse). Although it is generally accepted that D2 gastrectomy is the procedure of choice to achieve adequate oncologic excision, there are quite many concerns for its use in patients with early gastric cancer (EGC), where No or N1 specimens are frequently reported. The last two decades, with the evolvement of cancer cell detection techniques, the attend of the medical community is focused on GC patients with solitary lymphnode metastasis (SLN) or micrometastasis (mM). There is a discussion whether SLN should be attributed as the “real” sentinel node (SN) and its projection on patients' survival. The aim of this study is to review the recent literature and attempt to clarify the clinical significance of SLN in gastric cancer.
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Affiliation(s)
- Konstantinos D Mpallas
- 5th Surgical Department, Aristotle's University of Thessaloniki, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Vasileios I Lagopoulos
- 5th Surgical Department, Aristotle's University of Thessaloniki, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Apostolos G Kamparoudis
- 5th Surgical Department, Aristotle's University of Thessaloniki, Hippokrateio General Hospital, Thessaloniki, Greece
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7
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Lirosi MC, Biondi A, Ricci R. Surgical anatomy of gastric lymphatic drainage. Transl Gastroenterol Hepatol 2017; 2:14. [PMID: 28447049 DOI: 10.21037/tgh.2016.12.06] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/08/2016] [Indexed: 12/17/2022] Open
Abstract
The lymphatic system of the stomach is a multidirectional and complex network composed of lymphatic nodes and vessels. Lymph node metastasis is the most important prognostic factor in curable gastric cancer and lymph node dissection is one of the main areas of surgical research in gastric cancer. Therefore the anatomical classification and embryological development of the gastric lymphatic system have been well described in the literature. The current description of the gastric lymphatic system of the stomach has a surgical orientation and follows the recommendations of the Japanese Gastric Cancer Association. A thorough knowledge of the lymphatic system surrounding the stomach proves to be invaluable to surgeons treating patients with gastric cancer. The aim of this paper is to provide a concise review about surgical anatomy of the gastric lymphatic drainage.
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Affiliation(s)
- Maria Carmen Lirosi
- General Surgery Unit, Department of Surgery, "A. Gemelli" University Hospital Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Alberto Biondi
- General Surgery Unit, Department of Surgery, "A. Gemelli" University Hospital Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Ricci
- Department of Pathology, "A. Gemelli" University Hospital Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
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8
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Lymph node mapping with carbon nanoparticles and the risk factors of lymph node metastasis in gastric cancer. ACTA ACUST UNITED AC 2016; 36:865-870. [PMID: 27924502 DOI: 10.1007/s11596-016-1676-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/05/2016] [Indexed: 12/13/2022]
Abstract
The study aimed to examine the applicability of carbon nanoparticles as a tracer for lymph node mapping and the related factors of lymph node and No.8p subgroup metastasis in patients with gastric cancer. Clinical data of 50 patients with gastric cancer, who had not received treatment preoperatively and underwent gastrectomy in Department of Gastrointestinal Surgery, Wuhan Union Hospital, between October 2014 and August 2015, were retrospectively analyzed. These patients were found to have no distant metastasis preoperatively. Thirty-five out of 50 patients were subjected to lymphatic mapping technique using carbon nanoparticles as the tracer, and the rest 15 cases did not experience the lymphatic mapping and served as controls. The sensitivity, specificity, false positive rate and false negative rate were calculated according to the number of lymph nodes, and the staining and metastasis condition of lymph nodes. The diagnostic value of carbon nanoparticles on metastatic lymph nodes was evaluated. The relationship between the metastasis of lymph nodes or subgroup No.8p lymph nodes and clinicopathologic features was analyzed by χ2-test or Fisher's exact test. All patients underwent D2 surgery (lymph node dissection including all the group 1 and group 2 nodes) plus the dissection of the subgroup No.8p lymph nodes. It was found that the average number of harvested lymph nodes in lymphatic mapping technique group (45.7±14.5) was greater than that in control group (39.2±11.7), but the difference was not significantly different (P=0.138>0.05). The success rate, the accuracy, sensitivity, specificity and false negative rate was 97%, 57%, 28%, 62% and 72% respectively. The metastasis of lymph nodes was correlated to the depth of cancer invasion (T stage) (P=0.004<0.05), and the metastasis of No.8p lymph nodes was correlated to the extent of lymph node involvement (N stage) (P=0.007<0.05). Six cases had lymph node metastasis in subgroup No.8p, and their TNM stages and clinical stages were as follows: T1N2M0 IIA, T3N3M0 IIIB, T4aN3M0 IIIC, T4aN3M0 IIIC, T4aN3M0 IIIC, and T4bN3M0 IIIC. In conclusion, our study indicated that carbon nanoparticles failed to show good selectivity for metastatic lymph nodes; the result of lymphatic mapping does not achieve a satisfactory performance; the incidence of lymph node metastasis may increase, accompanying with the increase of the depth of cancer invasion; No.8p lymph node metastasis tends to occur for gastric carcinoma patients with the extent of lymph node metastasis over N2 stage.
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9
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Choi YY, An JY, Guner A, Kang DR, Cho I, Kwon IG, Shin HB, Hyung WJ, Noh SH. Skip lymph node metastasis in gastric cancer: is it skipping or skipped? Gastric Cancer 2016; 19:206-15. [PMID: 25708370 DOI: 10.1007/s10120-015-0472-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer. METHODS Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area. RESULTS After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95% confidence interval 1.13-2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95% confidence interval 0.92-2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001). CONCLUSIONS The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.
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Affiliation(s)
- Yoon Young Choi
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Ali Guner
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Dae Ryong Kang
- Department of Medical Humanities & Social Medicine, Office of Biostatistics, Ajou University School of Medicine, Seoul, Republic of Korea
| | - In Cho
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Department of Surgery, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - In Gyu Kwon
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Department of Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyun Beak Shin
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. .,Brain Korea 21 PLUS Project for Medical Science, Seoul, Republic of Korea.
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10
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Kim KH, Kim SH, Kim MC. How much progress has been made in minimally invasive surgery for gastric cancer in Korea?: a viewpoint from Korean prospective clinical trials. Medicine (Baltimore) 2014; 93:e233. [PMID: 25526443 PMCID: PMC4603086 DOI: 10.1097/md.0000000000000233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Gastric cancer is the most common cancer in Korea. Because the incidence of gastric cancer is still high even with early detection and because of developments in surgical instruments and technological advances, minimally invasive surgery has rapidly become an accepted treatment for gastric cancer in Korea. Many Korean gastric surgeons have contributed to the rapid adaptation of minimally invasive surgery for gastric cancer: not only the Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) group, but also other expert surgeons after the 2000s. Thanks to their vigorous efforts involving active learning, education, workshops, academic communications, and international communications with active laparoscopic gastric surgeons in Korea, numerous results and well-designed large-scale clinical studies have been published or are actively ongoing, thus increasing its wide acceptance as an option for gastric cancer. Now, Korea has become one of the leading countries using minimally invasive surgery for the treatment of gastric cancer. This review article will summarize the current status and issues, as well as the clinical trials that have finished or are ongoing, regarding minimally invasive surgery for gastric cancer in Korea.
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Affiliation(s)
- Ki-Han Kim
- From the Department of Surgery, Dong-A University College of Medicine, Busan, Korea
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11
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Kim DH, Choi MG, Noh JH, Sohn TS, Bae JM, Kim S. Clinical significance of skip lymph node metastasis in gastric cancer patients. Eur J Surg Oncol 2014; 41:339-45. [PMID: 25454830 DOI: 10.1016/j.ejso.2014.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/21/2014] [Accepted: 09/18/2014] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Given the recent increase in the incidence of early gastric cancer, there is greater interest in identifying a minimally invasive therapy. The purpose of this study was to analyze the patterns of lymph node metastasis in patients with gastric cancer and to elucidate the clinical significance of skip metastasis. METHODS We retrospectively analyzed patterns of lymph node metastasis (LNM) and clinicopathologic factors related to skip metastasis. RESULTS Among 2963 patients with gastric cancer, 997 patients (33.6%) were detected as having LNM, and 27 patients (2.7%) with skip metastasis were detected among 997 patients with LNM. Skip metastasis were detected more frequently in the elderly. Compared with the N1 group, the skip metastasis group showed lower frequency of vascular invasion, and compared with the stepwise N2 group, the skip metastasis group showed smaller tumor size and a significantly higher incidence of negative lymphatic, vascular, and perineural invasion. CONCLUSIONS Currently there is no way to predict N2 station LNM including skip metastasis, D2 LN dissection for gastric cancer is thought to be the appropriate treatment, even during early stage disease. Minimally invasive therapy should be performed cautiously in consideration of possible skip metastasis.
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Affiliation(s)
- D H Kim
- Department of Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - M G Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J H Noh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - T S Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J M Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - S Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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12
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Zhou J, Zhang Q, Li P, Shan Y, Zhao D, Cai J. Prognostic relevance of number and ratio of metastatic lymph nodes in resected carcinoma of the ampulla of Vater. Chin J Cancer Res 2014; 25:735-42. [PMID: 24385702 DOI: 10.3978/j.issn.1000-9604.2013.12.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/04/2013] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To explore the prognostic relevance of the number and ratio of metastatic lymph nodes in resected Carcinoma of the ampulla of Vater (CAV). METHODS The clinical data of 155 patients who underwent pancreaticoduodenectomy (PD) for cancer of the ampulla of Vater between January 1990 and December 2010 were retrospectively analyzed. Kaplan-Meier method was used in survival analysis and Log rank method in comparison. Multivariate analysis was performed using Cox proportional hazards model. RESULTS Among these 155 patients, the in-hospital mortality rate was 4.5%, lymph node positive disease was 21.3%, and the 5-year survival rate was 51.6%. Patients with a lymph node ratio (LNR) >20% were more likely to have tumor differentiation, depth of duodenal involvement, depth of pancreatic invasion, T-stage and TNM-Stage. The number of the metastatic lymph nodes is important prognostic factors of the CAV. Univariate analysis showed that the factors associated with the prognosis included tumor size (P=0.036), tumor differentiation (P=0.019), LNR (P=0.032), number of metastatic lymph nodes (P=0.024), lymph node metastasis (P=0.03), depth of pancreatic invasion (P=0.001), T-stage (P=0.002), TNM stage (P=0.001), elevated CA 19-9 (P=0.000), and jaundice (P=0.021). Multivariate analysis showed that the factors associated with the prognosis were the number of metastatic lymph nodes (P=0.032; RR: 1.283; 95% CI: 1.022-1.611), tumor size (P=0.043; RR: 1.736; 95% CI: 1.017-2.963), and elevated CA 19-9 (P=0.003; RR: 3.247; 95% CI: 1.504-7.010). CONCLUSIONS LNR is a useful factor for predicting the prognosis of the radical treatment for CAV, whereas the number of metastatic lymph nodes is the most important factor. Further research on the locations, number, and LNR will be clinically meaningful to improve survival in patients with CAV.
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Affiliation(s)
- Jianguo Zhou
- Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Qian Zhang
- Department of General Surgery, Aerospace Central Hospital, Beijing 100049, China
| | - Peng Li
- Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yi Shan
- Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Dongbing Zhao
- Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Jianqiang Cai
- Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
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Choi YY, An JY, Cho I, Kwon IG, Kang DR, Hyung WJ, Noh SH. The assessment of the oncological safety margin of insufficient lymph node dissection in pT2 (pm) gastric cancer. Yonsei Med J 2014; 55:61-9. [PMID: 24339288 PMCID: PMC3874921 DOI: 10.3349/ymj.2014.55.1.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To identify the effect of insufficient lymph node dissection (LND) on the survival of patients with pT2 gastric cancer. MATERIALS AND METHODS A total of 340 patients (120 patients with insufficient LND and others with D2 LND) who underwent gastrectomy for pT2 gastric cancer between January 2008 and December 2010 were included. RESULTS The incidence of preoperatively diagnosed early gastric cancer was higher and there were fewer metastatic lymph nodes (LNs) in the insufficient LND group than the D2 group, but there was no survival difference between two groups (p=0.365). Among the 89 patients with metastatic LNs after D2 LND, 13 patients (14.6%) had metastatic LNs at selected N2 stations (#10, 11, or 12a), but none of these patients were in the pN1 category. One patient had five metastatic LNs at station #11p with no metastatic LNs at any other stations. The number of metastatic LNs was identified as the only risk factor for LN metastasis at selected N2 stations by logistic regression. CONCLUSION If a patient has pN0 or pN1 category after insufficient LND for pT2 gastric cancer, the surgery can be regarded as secure. However, for patients with pN2 or pN3 category, more careful examination is required.
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Affiliation(s)
- Yoon Young Choi
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Lee JH, Lee HJ, Kong SH, Park DJ, Lee HS, Kim WH, Kim HH, Yang HK. Analysis of the lymphatic stream to predict sentinel nodes in gastric cancer patients. Ann Surg Oncol 2013; 21:1090-8. [PMID: 24276637 DOI: 10.1245/s10434-013-3392-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the pattern of lymphatic drainage in gastric cancer patients to predict sentinel node placement according to tumor location. METHODS A total of 462 pT1 or T2 gastric adenocarcinoma patients with metastasis to 1-3 lymph nodes (LNs) who had undergone lymphadenectomy greater than D1+β were included in the study. The distribution of metastatic LNs was evaluated according to tumor longitudinal and circumferential location. The incidence rate of atypical metastasis (skip or transversal metastasis) and related clinicopathologic factors were analyzed. RESULTS The rates of skip and transversal metastasis were 15.8 % (73 of 462) and 10.3 % (23 of 224), respectively. Atypical metastasis was observed regardless of tumor location. Tumors that showed the most frequent atypical metastasis were located in the lower third and lesser curvature (LC) of the stomach (29.0 % for skip metastasis and 18.0 % for transversal metastasis). In uni- and multivariate analyses, an LC tumor was a risk factor for skip metastasis, and tumor located circumferentially in the LC or longitudinally in the lower third of the stomach was an independent risk factor for transversal metastasis. There was no correlation between tumor aggressiveness and atypical metastasis. CONCLUSIONS Tumors at any location had a chance of atypical metastasis; however, those located longitudinally in the lower or circumferentially at the LC had a significantly higher chance of atypical metastasis compared to other locations. When sentinel node navigation surgery is applied, special care should be taken with tumors at these locations to prevent false-negative results.
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Affiliation(s)
- Ju-Hee Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Lee JH, Park DJ, Kim YH, Shin CM, Lee HS, Kim HH. Clinical Implementations of Preoperative Computed Tomography Lymphography in Gastric Cancer: A Comparison with Dual Tracer Methods in Sentinel Node Navigation Surgery. Ann Surg Oncol 2013; 20:2296-303. [DOI: 10.1245/s10434-012-2855-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Indexed: 12/23/2022]
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Vallbohmer D, Oh DS, Peters JH. The role of lymphadenectomy in the surgical treatment of esophageal and gastric cancer. Curr Probl Surg 2012; 49:471-515. [PMID: 22793506 DOI: 10.1067/j.cpsurg.2012.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ochiai T, Ikoma H, Inoue K, Komatsu S, Murayama Y, Shiozaki A, Kuriu Y, Nakanishi M, Ichikawa D, Fujiwara H, Okamoto K, Kokuba Y, Sonoyama T, Otsuji E. Long-term survival of a patient with common bile duct cancer after Virchow's node recurrence: Report of a case. Surg Today 2011; 41:1432-5. [PMID: 21922372 DOI: 10.1007/s00595-010-4447-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 10/18/2010] [Indexed: 11/24/2022]
Abstract
A 62-year-old male patient with common bile duct (CBD) cancer underwent pancreaticoduodenectomy with lymphadenectomy in 2002. Histological examinations revealed moderately differentiated tubular adenocarcinoma with lymph node metastasis around the pancreas head and hepatoduodenal ligament. No adjuvant chemotherapy was performed, due to the risk of side effects. Two years after the first operation, new lesions developed at the left supraclavicular area. These lesions were considered to be Virchow's node metastasis of the original CBD cancer. However, we could not detect any other metastatic lesions in the intraabdominal lymph nodes around the aorta. We resected the lesion. Histological examinations showed a similar histological appearance of this lesion to that of the CBD cancer resected in 2002. At present, the patient has survived for more than 80 months after receiving the second surgery. In selected cases, surgery might be considered even for a Virchow's node metastasis of CBD cancers if there are no other recurrent lesions.
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Affiliation(s)
- Toshiya Ochiai
- Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Sentinel lymph node biopsy is unsuitable for routine practice in younger female patients with unilateral low-risk papillary thyroid carcinoma. BMC Cancer 2011; 11:386. [PMID: 21888655 PMCID: PMC3224365 DOI: 10.1186/1471-2407-11-386] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 09/02/2011] [Indexed: 12/01/2022] Open
Abstract
Background Sentinel lymph node (SLN) biopsy has been used to assess patients with papillary thyroid carcinoma (PTC). To achieve its full potential the rate of SLN identification must be as close to 100 percent as possible. In the present study we compared the combination of preoperative lymphoscintigraphy scanning by sulfur colloid labeled with 99 m Technetium, gamma-probe guided surgery, and methylene blue with methylene blue, alone, for sentinel node identification in younger women with unilateral low-risk PTC. Methods From January 2004 to January 2007, 90 female patients, ages 23 to 44 (mean = 35), with unilateral low-risk PTC (T1-2N0M0) were prospectively studied. Mean tumor size was 1.3 cm (range, 0.8-3.7 cm). All patients underwent unilateral modified neck dissection. Prior to surgery, patients had, by random assignment, identification and biopsy of SLNs by methylene blue, alone (Group 1), or by sulfur colloid labeled with 99 m Technetium, gamma-probe guided surgery and methylene blue (Group 2). Results In the methylene blue group, SLNs were identified in 39 of 45 patients (86.7%). Of the 39 patients, 28 (71.8%) had positive cervical lymph nodes (pN+), and 21 patients (53.8%) had pSLN+. In 7 of the 28 pN+ patients (25%), metastases were also detected in non-SLN, thus giving a false-negative rate (FNR of 38.9% (7/18), a negative predictive value (NPV) of 61.1% (11/18), and an accuracy of 82.1% (32/39). In the combined technique group, the identification rate (IR) of SLN was 100% (45/45). Of the 45 patients, 27 (60.0%) had pN+, 24 (53.3%) had pSLN+. There was a FNR of 14.3% (3/21), a NPV of 85.7% (18/21), and an accuracy of 93.3% (42/45). The combined techniques group was significantly superior to the methylene blue group in IR (p = 0.035). There were no significant differences between two groups in sensitivity, specificity, NPV, or accuracy. Location of pN+ (55 patients) in 84 patients was: level I and V, no patients; level II, 1 patient (1.2%); level III, 6 patients (7.2%); level III and IV, 8 patients (9.5%); level IV, alone, 8 patients (9.5%); level VI, 32 patients (38.1%). In all 90 patients, IR of SLN was 93.3%, FNR, 25.6%, NPV, 74.4%, and accuracy rate, 88.1 percent. Conclusions Compared to a single technique, there was a significantly higher SLN identification rate for the combined technique in younger female with ipsilateral, low-risk PTC (T1-2N0M0). Thus, a combined SLN biopsy technique seems to more accurately stage lymph nodes, with better identification of SLN located out of the central compartment. Regardless of the procedure used, the high FNR renders the current SLN techniques unsuitable for routine practice. Based on these results, prophylactic node dissection of level VI might be considered because 38.1% of our patients had such node metastases.
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Kim HH, Ahn SH. The current status and future perspectives of laparoscopic surgery for gastric cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:151-62. [PMID: 22066116 PMCID: PMC3204545 DOI: 10.4174/jkss.2011.81.3.151] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 07/12/2011] [Accepted: 07/18/2011] [Indexed: 12/17/2022]
Abstract
Gastric cancer is most common cancer in Korea. Surgery is still the main axis of treatment. Due to early detection of gastric cancer, the innovation of surgical instruments and technological advances, gastric cancer treatment is now shifting to a new era. One of the most astonishing changes is that minimally invasive surgery (MIS) is becoming more dominant treatment for early gastric cancer. These MIS are represented by endoscopic resection, laparoscopic surgery, robotic surgery, single-port surgery and natural orifice transluminal endoscopic surgery. Among them, laparoscopic gastrectomy is most actively performed in the field of surgery. Laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) has already gained popularity in terms of the short-term outcomes including patient's quality of life. We only have to wait for the long-term oncologic results of Korean Laparoscopic Gastrointestinal Surgery Study Group. Upcoming top issues following oncologic safety of LADG are function-preserving surgery for EGC, application of laparoscopy to advanced gastric cancer and sentinel lymph node navigation surgery. In the aspect of technique, laparoscopic surgery at present could reproduce almost the whole open procedures. However, the other fields mentioned above need more evidences and experiences. All these new ideas and attempts provide technical advances, which will minimize surgical insults and maximize the surgical outcomes and the quality of life of patients.
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Affiliation(s)
- Hyung-Ho Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Huang B, Wang Z, Sun Z, Zhao B, Xu H. A novel insight of sentinel lymph node concept based on 1-3 positive nodes in patients with pT1-2 gastric cancer. BMC Cancer 2011; 11:18. [PMID: 21241483 PMCID: PMC3031262 DOI: 10.1186/1471-2407-11-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 01/17/2011] [Indexed: 12/15/2022] Open
Abstract
Background Sentinel node (SN) biopsy has been practiced in gastric cancer in recent years, and many studies focused on the distribution of solitary lymph node metastasis (SLM) to assess the pattern of SN. In fact, there is usually more than one SN existing in gastric cancer. The distribution of SNs needs to be further re-evaluated. Methods A total of 289 patients in pT1-2 stage with 1-3 positive nodes confined to same compartment were included in this study with informed consents. The primary lesion was solitary (≤ 5.0 cm in diameter) and D2 or D3 lymph node dissection had been performed. The location of metastatic lymph nodes was analyzed retrospectively. Results Most positive nodes occurred in N1 compartment, with frequency of 79.6% to 85.7% based on site of tumor. In the lower third of stomach, no. 6 was the most common metastatic site and no. 3 was the second; the order was reversed for SLM. With increasing depth of tumor invasion, a progressively augmented nodal involvement was shown. Nearly a half appeared transverse metastasis when the tumor located at the lesser or greater curvature. Among skip metastasis, no. 7, 8a, 9 and 11p were the most common metastatic sites and the prognosis was as similar as that of patients with N1 involved only. Conclusions The 1-3 positive nodes in the same compartment should be possible SNs, and most of which are restricted in N1 in pT1-2 gastric cancer. Transversal and 2 stations lymph node metastasis are common.
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Affiliation(s)
- Baojun Huang
- Department of Surgical Oncology, the First Hospital of China Medical University, Shenyang 110001, PR China
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21
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Abstract
BACKGROUND The operative methods for proximal gastric cancer differ depending on the institution, thus there is no optimal therapeutic strategy. A splenic hilum lymph node (No. 10) dissection is necessary for D2 operation for proximal gastric cancer, which means it requires splenectomy. However, unnecessary splenectomy should be avoided. METHODS A total of 127 proximal gastric cancer cases from our institution were studied retrospectively. In addition, 1,569 cases were collected from the literature and were used as pooled data for further analysis. All cases were examined for the depth of tumor invasion and lymph node metastasis. RESULTS A retrospective analysis revealed that proximal gastric cancer within submucosa (40 cases) had no N2 lymph node metastasis in our study. The 5-year overall survival of all cases was 25.2% and the disease-free survival was 23.6%. From the pooled data analysis, No. 10 lymph node metastasis was observed in 0.9% of the patients with submucosa proximal gastric cancer. Furthermore, there was no No. 4d lymph node metastasis when the depth of cancer was limited to within the subserosa. CONCLUSIONS Although a randomized, controlled trial concerning survival is necessary, according to this study, there is a possibility that limited resection might be accepted for proximal gastric cancer according to the depth of wall invasion.
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22
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Zhao D, Wu Y, Shan Y, Wang C, Zhao P. Prognostic factors of ampulla of vater carcinoma after radical surgery. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s11805-009-0085-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kendall C, Isabelle M, Bazant-Hegemark F, Hutchings J, Orr L, Babrah J, Baker R, Stone N. Vibrational spectroscopy: a clinical tool for cancer diagnostics. Analyst 2009; 134:1029-45. [PMID: 19475128 DOI: 10.1039/b822130h] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Vibrational spectroscopy techniques have demonstrated potential to provide non-destructive, rapid, clinically relevant diagnostic information. Early detection is the most important factor in the prevention of cancer. Raman and infrared spectroscopy enable the biochemical signatures from biological tissues to be extracted and analysed. In conjunction with advanced chemometrics such measurements can contribute to the diagnostic assessment of biological material. This paper also illustrates the complementary advantage of using Raman and FTIR spectroscopy technologies together. Clinical requirements are increasingly met by technological developments which show promise to become a clinical reality. This review summarises recent advances in vibrational spectroscopy and their impact on the diagnosis of cancer.
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Affiliation(s)
- Catherine Kendall
- Biophotonics Research Unit, Leadon House, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK GL1 3NN
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Grotenhuis BA, Wijnhoven BPL, van Marion R, van Dekken H, Hop WC, Tilanus HW, van Lanschot JJB, van Eijck CHJ. The sentinel node concept in adenocarcinomas of the distal esophagus and gastroesophageal junction. J Thorac Cardiovasc Surg 2009; 138:608-12. [PMID: 19698844 DOI: 10.1016/j.jtcvs.2008.11.061] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 10/17/2008] [Accepted: 11/27/2008] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The sentinel node concept is of great value in the treatment of various malignancies. In this study we investigated whether the application of the sentinel node procedure is feasible in esophageal adenocarcinoma and whether it can tailor surgical treatment of the individual patient. METHODS In 40 patients with an adenocarcinoma of the distal esophagus or gastroesophageal junction, blue dye was injected around the tumor intraoperatively. Sentinel nodes (blue-stained) and nonsentinel nodes were identified and dissected during transhiatal esophagectomy. In sentinel nodes negative for tumor cells on routine hematoxylin-eosin examination, multilevel sectioning and immunohistochemical staining were performed to search for micrometastases. RESULTS The sentinel node procedure was technically successful in 39 of 40 patients (98%). The median number of sentinel nodes identified was 4. Sentinel nodes were present in more than 1 nodal station in 8 patients (21%). In 6 patients in whom the sentinel node was negative for metastasis, nonsentinel nodes were positive for tumor cells (false-negative rate 6/39 = 15%). Micrometastases and isolated tumor cells were detected in 7 of 19 patients (37%) with sentinel nodes, but this finding did not affect the false-negative rate. CONCLUSION Detection of sentinel nodes is technically feasible during esophagectomy for cancer. However, given the relatively high false-negative rate of 15% and the high frequency of sentinel nodes in more than 1 nodal station, the clinical relevance of the sentinel node concept (through application of the blue dye technique) in the current treatment of patients with an adenocarcinoma of the distal esophagus or gastroesophageal junction seems limited.
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Lee YJ, Ha WS, Park ST, Choi SK, Hong SC, Park JW. Which biopsy method is more suitable between a basin dissection and pick-up biopsy for sentinel nodes in laparoscopic sentinel-node navigation surgery (LSNNS) for gastric cancer? J Laparoendosc Adv Surg Tech A 2008; 18:357-63. [PMID: 18503367 DOI: 10.1089/lap.2007.0024] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sentinel-node navigation surgery (SNNS) for breast cancer and melanoma has been accepted as a reasonable oncologic surgery worldwide. On the other hand, in gastric cancers that do metastasize well to the lymph node, the use of SNNS has been approached with care and performed in only limited cases. Some obstacles still have to be overcome, such as the shortcomings of SN tracers and the technical limitations of laparoscopic SN detection. The aims of this study were to determine whether laparoscopic SNNS is possible, and which biopsy method is more suitable for SN tracers, in gastric cancer, preoperatively diagnosed as < or =T2 and with < or =4-cm-sized lesions. MATERIALS AND METHODS Between January 2005 and October 2006, 92 consecutive patients that underwent LSNNS, using a combined indocyanine green and (99m)Tc-labeled tin colloid technique, were prospectively studied. SNs were laparoscopically removed by using two biopsy methods: a basin dissection and pick-up method, with the results of these two SN biopsy methods then compared with the final diagnosis obtained from a permanent section. RESULTS With the pick-up method, SNs were identified in 23 of 42 patients (54.8%); however, with basin dissection, the detection rate was 96% (48 of 50 patients). The average number of SNs detected by the two methods were 2.1 (range, 0-4) and 3.5 (range, 1-7), respectively. The sensitivities of the two methods were 66% (4/6) and 85.7% (12/14), with specificities of 100% (17/17) and 100% (34/34), respectively. CONCLUSION In gastric cancer, it was possible to perform LSNNS. At this moment, we believe the laparoscopic basin dissection technique with a dual-tracer injection, followed by SN detection on the back table, will be a reasonable procedure for gastric cancer, owing to the shortcomings related to the dye and radioisotope, the so-called "stained lymphatic duct only" and "shine-through phenomenon."
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Affiliation(s)
- Young-Joon Lee
- Department of Surgery, Gyeongsang National University Hospital, Jinju, Gyeongsang South Province, Korea. yjlee@
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Li C, Kim S, Lai JF, Oh SJ, Hyung WJ, Choi WH, Choi SH, Noh SH. Solitary lymph node metastasis in gastric cancer. J Gastrointest Surg 2008; 12:550-4. [PMID: 17786527 DOI: 10.1007/s11605-007-0285-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 07/29/2007] [Indexed: 02/07/2023]
Abstract
The feasibility and diagnostic reliability of sentinel node (SN) biopsy for gastric cancer are still controversial. We studied the clinicopathological features and localization of solitary lymph node metastasis (SLM) in gastric cancer to provide useful information for use of the SN concept in gastric cancer. From 2000 to 2004, 3,267 patients with gastric cancer underwent D2 radical gastrectomy. The clinicopathological features of 195 patients with histologically proven SLM and the distribution of metastasized nodes were assessed. The incidence of SLM was 6.0% in all cases. Compared with the node-negative patients, significant differences were observed in age, tumor size, depth of invasion, and surgical type. The cumulative 5-year survival rate of patients with SLM was 80.5%, which was significantly lower than 90.2% for node-negative patients (P<0.001). Of patients with SLM, 82.6% had it in the perigastric node area (N1), and the other 17.4% patients had skip metastasis in the N2-N3 nodes. Perigastric nodes were the most common first sites of drainage from the tumor, making them the main targets of the operative SN mapping procedure. Due to the higher than expected incidence of skip metastasis in gastric cancer, D2 lymphadenectomy should be performed until the reliability of SN navigation surgery is validated in multicenter prospective clinical trials.
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Affiliation(s)
- Chen Li
- Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-gu, Seoul, 120-752, South Korea
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Current status and future clinical applications of lymphatic mapping in gastrointestinal cancer. J Gastroenterol 2007; 42:927-31. [PMID: 18085348 DOI: 10.1007/s00535-007-2127-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 10/11/2007] [Indexed: 02/04/2023]
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Bembenek A, Gretschel S, Schlag PM. Sentinel lymph node biopsy for gastrointestinal cancers. J Surg Oncol 2007; 96:342-52. [PMID: 17726666 DOI: 10.1002/jso.20863] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Sentinel lymph node biopsy (SLNB) in gastrointestinal-(GI)-tract cancer is not yet of clinical relevance. Nevertheless, the results in the upper GI-tract promise to be helpful to individualize the indication for surgical therapy. SLNB in colon cancer still fails to show high validity to predict the nodal status, but may be helpful to clarify the prognostic role of micrometastases/isolated tumor cells. In anal cancer SLNB is able to guide the indication for groin irradiation.
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Affiliation(s)
- A Bembenek
- Department of Surgery and Surgical Oncology, Robert-Rössle-Klinik, Charité Universitätsmedizin Berlin, Campus Buch, Lindenberger, Berlin, Germany
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Liu CG, Lu P, Lu Y, Jin F, Xu HM, Wang SB, Chen JQ. Distribution of solitary lymph nodes in primary gastric cancer: A retrospective study and clinical implications. World J Gastroenterol 2007; 13:4776-80. [PMID: 17729400 PMCID: PMC4611200 DOI: 10.3748/wjg.v13.i35.4776] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy.
METHODS: We investigated 173 cases with solitary or single station metastatic lymph nodes (LN) from among 2476 gastric carcinoma patients. The location of metastatic LN, histological type and growth patterns were analyzed retrospectively.
RESULTS: Of 88 solitary node metastases cases, 65 were limited to perigastric nodes (N1), while 23 showed skipping metastasis. Among 8 tumors in the upper third stomach, 3 involved right paracardial LN (station number: No.1), and one in the greater curvature was found in No.1. In the 28 middle third stomach tumors, 10 were found in LN of the lesser curvature (No.3) and 6 in LN of the left gastric artery (No.7); 5 of the 20 cases on the lesser curvature spread to No.7, while 2 of the 8 on the greater curvature metastasized to LN of the spleen hilum (No.10). Of 52 lower third stomach tumors, 13 involved in No.3 and 19 were detected in inferior pyloric LN (No.6); 9 of the 29 cases along the lesser curvature were involved in No.6.
CONCLUSION: Transversal and skipping metastases of sentinel lymph nodes (SLN) are notable, and rational lymphadenectomy should, therefore, be performed.
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Affiliation(s)
- Cai-Gang Liu
- Department of Surgical Oncology, First Affiliated Hospital of China Medial University, Heping, Shenyang 110001, Liaoning Province, China
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Di Leo A, Marrelli D, Roviello F, Bernini M, Minicozzi A, Giacopuzzi S, Pedrazzani C, Baiocchi LG, de Manzoni G. Lymph node involvement in gastric cancer for different tumor sites and T stage: Italian Research Group for Gastric Cancer (IRGGC) experience. J Gastrointest Surg 2007; 11:1146-53. [PMID: 17576611 DOI: 10.1007/s11605-006-0062-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of lymphadenectomy is to clear all the metastatic nodes achieving a complete removal of the tumor; nevertheless, its role in gastric cancer has been very much debated. MATERIALS AND METHODS The frequency of node metastasis in each lymphatic station according to the International Gastric Cancer Association, was studied in 545 patients who underwent D2 or D3 lymphadenectomy from June 1988 to December 2002. RESULTS Upper third early cancers have shown an involvement of N2 celiac nodes in 25%. In advanced cancers, there was a high frequency of metastasis in the right gastroepiploic (from 10% in T2 to 50% in T4) and in the paraaortic nodes (26% in T2, 32% in T3, 38 % in T4). N3 left paracardial nodes involvement was observed in an important share of middle third tumors (17% in T3, 36% in T4). Splenic hilum nodes metastasis were common in T3 and T4 cancers located in the upper (39%) and middle (17%) stomach. N2 nodal involvement was frequent in lower third advanced cancers. Metastasis in M left paracardial and short gastric nodes were observed in a small percentage of cases. CONCLUSION Given the nodal diffusion in our gastric cancer patients, extended lymphadenectomy is still a rationale to obtain radical resection.
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Affiliation(s)
- Alberto Di Leo
- First Division of General Surgery, University of Verona, Verona, Italy.
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31
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Abstract
Sentinel node (SN) concept is valid in gastrointestinal (GI) malignancies. The dual tracer method with radio-guided and dye-guided SN mapping is feasible in GI malignancies and is useful in detecting unexpected aberrant drainage routes from GI cancers. SN mapping enabled us to perform individualized and step-wise lymphadenectomy in patients with GI cancer. A combination of SN mapping and endoscopic surgery will contribute to the improvement in quality of life after surgical treatment of GI cancer.
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Affiliation(s)
- Yuko Kitagawa
- Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Leong SPL, Cady B, Jablons DM, Garcia-Aguilar J, Reintgen D, Werner JA, Kitagawa Y. Patterns of metastasis in human solid cancers. Cancer Treat Res 2007; 135:209-221. [PMID: 17953419 DOI: 10.1007/978-0-387-69219-7_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Stanley P L Leong
- Department of Surgery, University of California San Francisco, California, USA
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33
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Abstract
During the twentieth century, surgical management of gastroesophageal carcinoma was developed by an establishment of standard procedures with lymph node dissection according to the metastatic distribution. The "fear" of invisible micrometastasis caused surgeons to perform more aggressive resection with lymphadenectomy to control the disease locally. Although several promising results of extensive lymph node dissection have been reported, the prognostic benefits of extensive surgery have not been proven by prospective randomized trials. A novel technology to detect micrometastasis without extensive surgical resection is required to gastroesophageal carcinoma. The lymphatic mapping technique is one of the attractive candidates for a novel tool to approach this issue.
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Affiliation(s)
- Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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34
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Leong SPL, Cady B, Jablons DM, Garcia-Aguilar J, Reintgen D, Jakub J, Pendas S, Duhaime L, Cassell R, Gardner M, Giuliano R, Archie V, Calvin D, Mensha L, Shivers S, Cox C, Werner JA, Kitagawa Y, Kitajima M. Clinical patterns of metastasis. Cancer Metastasis Rev 2006; 25:221-32. [PMID: 16770534 DOI: 10.1007/s10555-006-8502-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In human solid cancer, lymph node status is the most important indicator for clinical outcome. Recent developments in the sentinel lymph node concept and technology have resulted in a more precise way of examining micrometastasis in the sentinel lymph node and the role of lymphovascular system in the facilitation of cancer metastasis. Different patterns of metastasis are described with respect to different types of solid cancer. Expect perhaps for papillary carcinoma and sarcoma, the overwhelming evidence is that solid cancer progresses in an orderly progression from the primary site to the regional lymph node or the sentinel lymph node in the majority of cases with subsequent dissemination to the systemic sites. The basic mechanisms of cancer metastasis through the lymphovascular system form the basis of rational therapy against cancer. Beyond the clinical patterns of metastasis, it is imperative to understand the biology of metastasis and to characterize patterns of metastasis perhaps due to heterogeneous clones based on their molecular signatures.
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Affiliation(s)
- Stanley P L Leong
- Department of Surgery, University of California, and UCSF Comprehensive Cancer Center, San Francisco, CA, USA.
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35
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Mura G, Vagliasindi A, Framarini M, Mazza P, Solfrini G, Verdecchia GM. The sentinel node biopsy in early gastric cancer: a preliminary study. Langenbecks Arch Surg 2006; 391:113-7. [PMID: 16525854 DOI: 10.1007/s00423-005-0018-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 12/07/2005] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Sentinel node biopsy is currently used in surgery of malignant melanoma and breast cancer. The feasibility of sentinel node mapping in gastrointestinal cancers and its diagnostic sensitivity is unclear. It could be of particular value in the management of early gastric cancer in which radical D2 lymphadenectomy may be unnecessary. MATERIALS AND METHODS From January 2004 to June 2005, ten patients with preoperative diagnosis of early gastric cancer and no nodal involvement (cT1N0) were submitted to sentinel node biopsy using the dual mapping procedure with endoscopic blue dye and 99mTc radio colloid injection. All the patients underwent standard radical gastrectomy and D2 lymphadenectomy. The resected nodes were evaluated by routine (hematoxylin-eosin) histopathological examination; the sentinel (blue or hot) nodes, in addition, were evaluated with immunohistochemistry for cytokeratin. RESULTS The detection rate of this procedure was 100%. The preliminary results and perspectives for feasibility of sentinel node biopsy and its accuracy in predicting the nodal status in early gastric cancer are discussed.
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Affiliation(s)
- Gianni Mura
- Division of Surgery and Advanced Cancer Therapies, Morgagni Hospital-Forlì (Italy), Via Forlanini, 47100, Forlì, Italy.
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36
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Lee YJ, Moon HG, Park ST, Choi SG, Hong SC, Jung EJ, Joo YT, Jeong CY, Ha WS. The value of intraoperative imprint cytology in the assessment of lymph node status in gastric cancer surgery. Gastric Cancer 2006; 8:245-8. [PMID: 16328599 DOI: 10.1007/s10120-005-0347-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 09/22/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND The intraoperative assessment of lymph node status is important when performing limited surgery in gastric cancer patients. Currently available techniques for this assessment are frozen section, imprint cytology, and other molecular methods; most current studies use the frozen-section method. In the present study, we focused on the accuracy and feasibility of imprint cytology as a tool to assess lymph node status intraoperatively in gastric cancer surgery. METHODS Between April 2001 and March 2003, we performed imprint cytology of the sentinel nodes in 260 consecutive patients. After review by an experienced cytopathologist, the sensitivity, specificity, and overall accuracy of the method were determined. RESULTS The time required for the intraoperative imprint cytology was 8 min, and the sensitivity, specificity, and overall accuracy were 52.2%, 88.8%, and 73.8%, respectively. CONCLUSION Imprint cytology could be a useful technique for the assessment of lymph node status intraoperatively if the sensitivity and specificity can be improved to an acceptable level.
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Affiliation(s)
- Young-Joon Lee
- Department of Surgery, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, 90 Chilam-dong, Jinju 660-702, Gyeongsangnam-do, South Korea
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37
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Suga K, Shimizu K, Kawakami Y, Tangoku A, Zaki M, Matsunaga N, Oka M. Lymphatic drainage from esophagogastric tract: feasibility of endoscopic CT lymphography for direct visualization of pathways. Radiology 2006; 237:952-60. [PMID: 16304114 DOI: 10.1148/radiol.2373041578] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the feasibility of an endoscopic computed tomographic (CT) lymphography technique with submucosal injection of iopamidol for direct visualization of lymphatic drainage pathways in dogs and in patients with operable esophageal cancer. MATERIALS AND METHODS With institutional animal committee approval, a total of 2 mL of undiluted iopamidol was injected into the esophageal (n = 6) or gastric (n = 3) submucosa in nine dogs by using a flexible endoscope. Multi-detector row CT images (section thickness, 1.25 mm) were obtained before contrast material injection and during the 10 minutes after injection. The animals were euthanized so that their lymphatic anatomy could be examined. With ethical committee approval and patient informed consent, nine patients with esophageal cancer also underwent CT lymphography with peritumoral injection of 2 mL of iopamidol, followed by esophagectomy and regional lymph node dissection with CT lymphographic guidance. The histopathologic features of dissected nodes, including sentinel lymph nodes (SLNs), were examined. RESULTS CT lymphography depicted the direct connection of lymphatic drainage vessels with enhanced and/or unenhanced nodes (ie, SLNs) as early as within 5 minutes after contrast material injection in all subjects. All 13 SLNs in dogs (1.4 nodes per animal) and 18 SLNs in patients (two nodes per patient) were found and dissected at the correct location by using CT lymphographic guidance. In patients, histopathologic examination revealed the high predictive value of CT lymphographic-guided SLN biopsy: Only one of the preoperatively identified SLNs in three patients and both SLNs and adjacent nodes in two patients were positive for metastasis; all resected nodes in the remaining four patients were negative. CONCLUSION Endoscopic CT lymphography is a feasible method for visualizing the direct connection between and the accurate anatomic location of SLNs and lymphatic drainage vessels.
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Affiliation(s)
- Kazuyoshi Suga
- Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
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38
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Abstract
BACKGROUND Several studies have shown the features of skip metastasis in other cancers besides gastric cancer. Since minimally invasive surgery has been applied to gastric cancer, the concerns and awareness of skip metastasis have grown in the medical community. We conducted the present retrospective study to reveal the clinicopathological characteristics of patients with skip metastasis. We also wished to clarify the clinical impact of skip metastasis for gastric cancer. METHODS Five hundred and eighty-nine patients having lymphatic metastases were enrolled in the present study. Among them, 266 patients had positive nodes extending into the N2 group. We divided these patients into the skip positive (+) and the skip negative (-) group, and we comparatively analysed clinicopathological factors and calculated the survival probabilities for the two groups. RESULTS The skip (+) and skip (-) groups involved 14 (5.3%) and 252 (94.7%) patients, respectively. Of all the investigated factors, a significant difference between two groups was observed only in the total number of retrieved nodes. Stations of skip nodes were along left gastric (7), anterior common hepatic (8a), celiac (9), splenic (11) artery and right paracardial nodes (1). The survival curves calculated in the present study did not show any statistical differences between the groups. CONCLUSIONS Due to problems of skip metastasis in gastric cancer, D2 lymph node dissection should be performed until sentinel node detection is feasible and reliable. The potential risk from skip metastasis is not great and skip metastasis itself should not be a major consideration in therapeutic decisions.
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Affiliation(s)
- Sung-Soo Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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39
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Cheng LY, Chen XD, Xie ZY, Zhou HF, Zhong SZ. Clinical significance of ex vivo detection of sentinel lymph node in gastric cancer. Shijie Huaren Xiaohua Zazhi 2005; 13:2156-2159. [DOI: 10.11569/wcjd.v13.i17.2156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the feasibility of ex vivo sentinel lymph node (SLN) mapping and its clinical significance in improving the staging of gastric cancer.
METHODS: Nineteen patients received curative resection of primary gastric cancer with extended lymph node dissection were included in this study. Gastric specimens were submucosally or subserosally injected with 10 g/L Patent Blue. The blue-stained SLNs were excised for routine pathological examination (hematoxylin and eosin staining). The SLNs, which were negative after HE staining, were further examined by cytokeratin immunohistochemistry.
RESULTS: The SLNs were identified in 89.5%(17/19) cases, with a mean number of 1.4 (1-3) for each case. After HE staining, the accuracy of the SLNs in diagnosis of the regional lymph node metastasis was 70.5% (12/17), and the false-negative rate was 38.4%. However, one case (25%) was upstaged by cytokeratin immunohistochemistry. Thus, the diagnostic accuracy increased to 88.2% and the false-negative rate decreased to 14.2%.
CONCLUSION: Ex vivo SLN mapping in gastric cancer is technically feasible and may upstage some of the gastric cancer.
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40
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Gretschel S, Bembenek A, Ulmer C, Hünerbein M, Markwardt J, Schneider U, Schlag PM. Prediction of gastric cancer lymph node status by sentinel lymph node biopsy and the Maruyama computer model. Eur J Surg Oncol 2005; 31:393-400. [PMID: 15837046 DOI: 10.1016/j.ejso.2004.11.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Revised: 11/15/2004] [Accepted: 11/23/2004] [Indexed: 12/12/2022] Open
Abstract
AIMS The extent of lymph node dissection in gastric cancer remains controversial. The Maruyama computer model and the sentinel lymph node biopsy (SLNB) are compared for their value to predict the nodal status and lead to stage-adapted surgery. METHODS Thirty four patients with stage I-IV gastric cancer underwent both staging procedures. For SLNB, 15 patients underwent endoscopic, peri-tumoural injection of (99m)Tc-colloid, and 19 patients were injected of Patent blue V. All 'hot' or blue sentinel lymph nodes (SLNs) were separately excised and histopathologically assessed. If the SLN was negative after routine staining by H&E, it was processed completely and reanalysed after immunohistochemistry. RESULTS At least, one SLN was detected by means of SLNB in 33/34 of the patients. The sensitivity to identify a positive nodal status was 22/33 and the specificity/positive predictive value was 10/10 and 22/22. Additional micrometastases or isolated tumour cells in the SLN led to 'upstaging' of 5/15, initially classified as nodal negative by H&E-staining. Using the Maruyama computer model, a sensitivity of 22/23 for the correct prediction of the lymph node involvement was associated with a specificity of 2/10 and a positive predictive value of 22/30. CONCLUSIONS The clinical impact of the Maruyama computer model is limited due to low specificity and a low positive predictive value, rendering the method less useful as an indicator for individualised surgery.
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Affiliation(s)
- S Gretschel
- Department of Surgery and Surgical Oncology, Universitätsmedizin Berlin, Charité Campus Berlin-Buch, Robert-Rössle Hospital, Lindenberger Weg 80, D-13122 Berlin, Germany
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41
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Kitagawa Y, Fujii H, Mukai M, Kubo A, Kitajima M. Sentinel lymph node mapping in esophageal and gastric cancer. Cancer Treat Res 2005; 127:123-39. [PMID: 16209080 DOI: 10.1007/0-387-23604-x_6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In recent years, the sentinel lymph node (SLN) concept has been widely investigated in a variety of solid tumors including gastrointestinal (GI) cancer. This chapter reviews the rationale and refined technical aspects for SLN mapping in upper GI cancer for the intraoperative accurate diagnosis of nodal status to perform individualized minimally invasive surgical approaches. We have described the technical details of the procedure as we have performed it in over 350 consecutive patients with esophageal and gastric cancer and introduced pitfalls and issues remaining. The technical details and clinical applications of SLN mapping differfor patients with esophageal cancer and gastric cancer. Radio-guided method with lymphoscintigraphy using radioisotope-labeled colloid (RI) is essential for SLN mapping for esophageal cancer. Selective lymphadenectomy and SLN-targeted chemoradiotherapy would be feasible and beneficial for the patients with esophageal cancer. For gastric cancer, combined method with dye and RI is recommended for stable and accurate sampling of SLN in the laparoscopic setting. Laparoscopic local resection for superficial gastric cancer with negative SN status would be a reasonable and less-invasive novel procedure based on the SLN concept. We can utilize this procedure not only for an accurate staging but also as a great tool to change the patient care of upper GI cancer by individualized minimally invasive treatments.
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Affiliation(s)
- Yuko Kitagawa
- Department of Surgery, Keio University, School of Medicine, Tokyo, Japan
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42
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Jeziorski A. Sentinel node mapping in gastric cancer. Rep Pract Oncol Radiother 2005. [DOI: 10.1016/s1507-1367(05)71087-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lamb PJ, Griffin SM, Burt AD, Lloyd J, Karat D, Hayes N. Sentinel node biopsy to evaluate the metastatic dissemination of oesophageal adenocarcinoma. Br J Surg 2004; 92:60-7. [PMID: 15584066 DOI: 10.1002/bjs.4693] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Background
The aim of this study was to determine the feasibility and accuracy of sentinel lymph node (SLN) biopsy for oesophageal adenocarcinoma.
Methods
Fifty-seven patients with adenocarcinoma of the lower oesophagus (n = 40) or gastric cardia (n = 17) underwent endoscopic peritumoral injection of 99mTc-radiolabelled nanocolloid before en bloc resection with extended lymphadenectomy. SLNs were identified during surgery using a handheld γ probe and the pattern of radioactive uptake was quantified after operation. All 1667 resected lymph nodes were examined immunohistochemically for micrometastases.
Results
SLNs were identified in all 57 patients. They contained metastases (n = 32) or micrometastases (n = 3) in 35 of 37 node-positive patients and there were two false-negative studies. The overall accuracy of SLN biopsy was 96 per cent and SLNs were more likely to contain tumour than other lymph nodes (P < 0·001). Tumour-infiltrated nodal stations had a higher proportion of radioactive uptake (P < 0·001). Lower oesophageal tumours had a greater proportion of SLNs (P = 0·018), radioactive uptake (P < 0·001) and malignant nodes (P = 0·004) in the mediastinum than gastric cardia tumours.
Conclusion
The sentinel node concept is applicable to oesophageal adenocarcinoma and could be used to tailor the extent of lymphadenectomy. There is a close relationship between patterns of radioactive uptake and lymphatic tumour dissemination, which differ for lower oesophageal and gastric cardia tumours.
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Affiliation(s)
- P J Lamb
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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44
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Schlag PM, Bembenek A, Schulze T. Sentinel node biopsy in gastrointestinal-tract cancer. Eur J Cancer 2004; 40:2022-32. [PMID: 15341974 DOI: 10.1016/j.ejca.2004.04.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Accepted: 04/22/2004] [Indexed: 10/26/2022]
Abstract
Forty three years after Gould's first description of the sentinel lymph node (SN) technique in malignant tumours of the parotid, sentinel lymph node biopsy (SLNB) has become an invaluable tool for the treatment of solid tumours. In some tumour types, it has been shown to reliably reflect the lymph node (LN) status of the tumour-draining LN basin. In melanoma and breast cancers, it has become a widely accepted element in the routine surgical management of these malignant diseases. In gastrointestinal tumours, the technique is currently under intense investigation. First reports on its application in other solid tumours like non-small cell lung cancer, thyroid carcinoma, oropharyngeal carcinoma, vulvar carcinoma, and Merkel Cell carcinoma of the skin were published more recently. In the following review, we will give a synopsis of the fundamentals of the SN concept and will then proceed to an overview of recent advances of SLNB in gastrointestinal cancers.
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Affiliation(s)
- P M Schlag
- Klinik für Chirurgie und Chirurgische Onkologie, Universitätsmedizin Berlin, Robert-Rössle-Klinik Berlin, Charité, Campus Buch, Lidenberger Weg 80, 13125, Germany.
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45
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Cheng LY, Zhong SZ, Huang ZH. Sentinel lymph node concept in gastric cancer with solitary lymph node metastasis. World J Gastroenterol 2004; 10:3053-5. [PMID: 15378792 PMCID: PMC4576271 DOI: 10.3748/wjg.v10.i20.3053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2004] [Revised: 02/18/2004] [Accepted: 02/24/2004] [Indexed: 12/15/2022] Open
Abstract
AIM To study the localization of the solitary metastases in relation to the primary gastric cancers and the feasibility of sentinel lymph node (SLN) concept in gastric cancer. METHODS Eighty-six patients with gastric cancer, who had only one lymph node involved, were regarded retrospectively as patients with a possible sentinel node metastasis, and the distribution of these nodes were assessed. Thirteen cases with jumping metastases were further studied and followed up. RESULTS The single nodal metastasis was found in the nearest perigastric nodal area in 65.1% (56/86) of the cases and in 19.8% (17/86) of the cases in a fairly remote perigastric area. Out of 19 middle-third gastric cancers, 3 tumors at the lesser or greater curvatures had transverse metastases. There were also 15.1% (13/86) of patients with a jumping metastasis to N2-N3 nodes without N1 involved. Among them, the depth of invasion was mucosal (M) in 1 patient, submucosal (SM) in 2, proper-muscular (MP) in 4, subserosal (SS) in 5, and serosa-exposed (SE) in 1. Five of these patients died of gastric cancer recurrence at the time of this report within 3 years after surgery. CONCLUSION These results suggest that nodal metastases occur in a random and multidirectional process in gastric cancer and that not every first metastatic node is located in the perigastric region near the primary tumor. The rate of "jumping metastasis" in gastric cancer is much higher than expected, which suggests that the blind examination of the nodal area close to the primary tumor can not be a reliable method to detect the SLN and that a extended lymph node dissection (ELND) should be performed if the preoperative examination indicates submucosal invasion.
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Affiliation(s)
- Li-Yang Cheng
- Institute of Clinical Anatomy, First Military Medical University, Guangzhou 510515, Guangdong Province, China.
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46
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Schulze T, Bembenek A, Schlag PM. Sentinel lymph node biopsy progress in surgical treatment of cancer. Langenbecks Arch Surg 2004; 389:532-50. [PMID: 15197548 DOI: 10.1007/s00423-004-0484-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Accepted: 03/04/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Forty-three years after the first description of the sentinel lymph node technique in malignant tumours of the parotid by Gould, sentinel lymph node biopsy (SNLB) has become a precious tool in the treatment of solid tumours. METHODS In the following review we give a synopsis of the fundamentals of the sentinel lymph node concept and then proceed to an overview of recent advances of SNLB in gastrointestinal cancers. RESULTS In some tumour entities, SNLB has been shown to reflect reliably the lymph node status of the tumour-draining lymph node basin. In melanoma and breast cancer, it became a widely accepted element of the routine surgical management of these malignant diseases. In gastrointestinal tumours, the technique is currently under intense investigation. First reports on its application in other solid tumours, such as non-small cell lung cancer, thyroid carcinoma, oropharyngeal carcinoma, vulvar carcinoma, and Merckel cell carcinoma of the skin, were published more recently. CONCLUSION SNLB has become an important component of diagnosis and treatment of solid tumours. A growing number of publications on SNLB in gastrointestinal cancer documents the interest of many investigators in the application of this technique in this tumour entity. As long as imaging techniques like 18FDG PET or other molecular imaging techniques are limited by their spatial resolution, SNLB remains the technique of choice for lympho-nodal staging.
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Affiliation(s)
- T Schulze
- Klinik für Chirurgie und Klinische Onkologie, Charité, Campus Buch, Robert-Rössle-Klinik im HELIOS Klinikum Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
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Abstract
Recent studies on lymphatic mapping of upper gastrointestinal (GI) malignancies have provided new insights with regard to the sentinel node (SN) concept in solid tumors. At present, the SN concept seems to be valid not only for breast cancer, but also for esophageal and gastric cancers, which have multidirectional and complicated lymphatic flows. In addition to the staging merits, individualized surgical management has been proposed for upper GI cancer based on the SN concept. Gastric cancer is now a suitable target of SN-guided surgery after breast cancer because of its anatomical situation. Laparoscopic local resection is theoretically feasible for curative treatment of SN-negative early gastric cancer. Because SNs in esophageal cancer are multiple and widespread, complete sampling of SNs is not a minimally invasive procedure, as it is in breast cancer. However, selective and modified lymphadenectomy targeting SNs for clinically N0 esophageal cancer instead of three-field lymph node dissection should become not only feasible but also clinically important. When performing chemoradiotherapy as curative treatment for cT1N0 esophageal cancer, lymphoscintigrams revealing the distribution of SNs in each individual case are useful to tailor the field of irradiation to control occult micrometastases. Although there are several issues to be resolved, this novel procedure has the potential to improve quality control in upper GI cancer.
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Affiliation(s)
- Yuko Kitagawa
- Department of Surgery, Keio University, School of Medicine, Tokyo, Japan
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Nimura H, Narimiya N, Mitsumori N, Yamazaki Y, Yanaga K, Urashima M. Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg 2004; 91:575-9. [PMID: 15122608 DOI: 10.1002/bjs.4470] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND To avoid unnecessary lymphadenectomy in patients with cancer accurate diagnosis of the sentinel lymph node (SLN) is important. METHODS This report examined the initial clinical use of infrared ray electronic endoscopy (IREE) combined with indocyanine green (ICG) injection for SLN detection in 84 patients with gastric cancer not invading the subserosa (75 T1 N0 M0 and nine T2 N0 M0 tumours, according to tumour node metastasis classification). RESULTS There were no adverse events after injection of ICG. At least one SLN was detected in all but one patient by both ICG injection alone and by IREE with ICG. Eleven of the 84 patients had lymph node metastasis. SLNs detected by ICG injection alone did not include metastases in four of 11 patients, whereas IREE with ICG detected SLNs containing lymph node metastases in all 11 patients. Moreover, SLNs illuminated by IREE with ICG included all metastases among the 105 regional lymph nodes in the 11 patients; no metastatic lymph nodes were identified among 154 non-SLNs. CONCLUSION IREE combined with ICG injection may efficiently detect SLNs that contain metastases in patients with gastric cancer.
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Affiliation(s)
- H Nimura
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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Song X, Wang L, Chen W, Pan T, Zhu H, Xu J, Jin M, Finley RK, Wu J. Lymphatic mapping and sentinel node biopsy in gastric cancer. Am J Surg 2004; 187:270-3. [PMID: 14769318 DOI: 10.1016/j.amjsurg.2003.11.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2002] [Revised: 11/16/2003] [Indexed: 12/19/2022]
Abstract
BACKGROUND To determine the feasibility and significance of lymphatic mapping and sentinel lymph node biopsy (SLNB) in patients with gastric cancer. METHODS From August 1999 to January 2002, 27 gastric cancer patients underwent lymphatic mapping and sentinel lymph node biopsy using isosulfan blue dye. RESULTS The success rate of SLNB was 96.3% (26 of 27). Accuracy, sensitivity, and specificity were 100%. There were no false negatives. In 26 successful cases, 8 patients had positive sentinel lymph nodes and 18 had negative sentinel nodes. Of 8 patients with positive sentinel nodes, 6 had positive sentinel nodes only at N1 lymph node station, 1 only at N2 station, and 1 had positive sentinel nodes at both N1 and N2 stations. Of 18 patients with negative sentinel lymph nodes, 9 patients had sentinel nodes only at N1, 3 only at N2, 5 at both N1 and N2, and 1 at both N1 and N3. There were no cases in which sentinel lymph nodes were the only sites of metastases. CONCLUSIONS Sentinel lymph node biopsy using isosulfan blue dye in gastric cancer is a feasible procedure with high sensitivity and accuracy. Sentinel lymph nodes demonstrate the varied lymphatic drainage. If the sentinel nodes at N2 are positive, it will guide surgeons to do a more extended lymph node dissection in early stage gastric cancer.
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Affiliation(s)
- Xiangyang Song
- Oncology Center, Sir Run Run Shaw Hospital and Sir Run Run Shaw Clinical Medical Institute, Medical College of Zhejiang University, Hangzhou, Zhejiang Province, 310016, China
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Arai K, Iwasaki Y, Takahashi T. Clinicopathological analysis of early gastric cancer with solitary lymph node metastasis. Br J Surg 2002; 89:1435-7. [PMID: 12390388 DOI: 10.1046/j.1365-2168.2002.02204.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The sentinel node concept has not yet been established in gastric cancer. METHODS Fifty-four patients with early gastric cancer who had only one lymph node metastasis were regarded retrospectively as patients with a possible sentinel node metastasis, and the morphological features of these nodes were assessed. The level I nodes in seven patients with a possible skip metastasis at routine haematoxylin and eosin staining were re-examined using cytokeratin (CK) immunostaining. RESULTS The shape of the gastric cancer lesion could be examined in 53 of the patients; more than one-third (20 of 53) were microfocal type. Concerning the intranodal cancer foci, the marginal sinus type was found in 32 affected nodes, medullary sinus type in 14 and mixed type in seven. Forty-three per cent of suspected sentinel nodes were the largest in size among all nodes from the station. CK immunostaining of seven non-metastatic nodes with haematoxylin and eosin revealed that three were CK positive. CONCLUSION These findings suggest that possible sentinel nodes detected by conventional means may not always be primary portions of any metastasis. Adoption of sentinel node biopsy in gastric cancer must await the development of improved procedures for diagnosis during surgery.
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Affiliation(s)
- K Arai
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan. arai.k.-
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