Griniatsos J, Gakiopoulou H, Yiannakopoulou E, Dimitriou N, Douridas G, Nonni A, Liakakos T, Felekouras E. Routine modified D2 lymphadenectomy performance in pT1-T2N0 gastric cancer. World J Gastroenterol 2009; 15(44): 5568-5572 [PMID: 19938196 DOI: 10.3748/wjg.15.5568]
Corresponding Author of This Article
John Griniatsos, MD, Assistant Professor, 1st Department of Surgery, University of Athens, Medical School, LAIKO Hospital, 17 Agiou Thoma street, GR 115-27, Athens, Greece. johngriniatsos@yahoo.com
Article-Type of This Article
Brief Article
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John Griniatsos, Eugenia Yiannakopoulou, Nikoletta Dimitriou, Gerasimos Douridas, Evangelos Felekouras, 1st Department of Surgery, University of Athens, Medical School, LAIKO Hospital, GR 115-27, Athens, Greece
Hara Gakiopoulou, Afrodite Nonni, Department of Pathology, University of Athens, Medical School, LAIKO Hospital, GR 115-27, Athens, Greece
Theodoros Liakakos, 3rd Department of Surgery, University of Athens, Medical School, ATTIKO Hospital, GR 115-27, Athens, Greece
Author contributions: Griniatsos J and Felekouras E designed the study, performed the operations and contributed to the preparation of the manuscript; Yiannakopoulou E and Dimitriou N wrote the manuscript; Gakiopoulou H and Nonni A performed the histopathology and immunohistochemistry; Douridas G performed the operations and reviewed the literature; Liakakos T checked the final version of the manuscript and made significant comments.
Correspondence to: John Griniatsos, MD, Assistant Professor, 1st Department of Surgery, University of Athens, Medical School, LAIKO Hospital, 17 Agiou Thoma street, GR 115-27, Athens, Greece. johngriniatsos@yahoo.com
Telephone: +30-210-7456855 Fax: +30-210-7771195
Received: August 11, 2009 Revised: September 7, 2009 Accepted: September 15, 2009 Published online: November 28, 2009
Abstract
AIM: To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemically detected skip micrometastases in level II lymph nodes.
METHODS: Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0. All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the level I lymph node stations (n = 4) were excluded from further analysis. The level II lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study.
RESULTS: Skip micrometastases in the level II lymph nodes were detected in 14% (4 out of 28) of the patients. The incidence was further increased to 17% (4 out of 24) in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No. 7 lymph node station. Thus, the disease was upstaged from stage IA to IB in one patient and from stage IB to II in three patients.
CONCLUSION: In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.
