Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2020; 12(6): 277-286
Published online Jun 27, 2020. doi: 10.4240/wjgs.v12.i6.277
Efficacy of the fat-dissociation method for nodal harvesting in gastric cancer
Shinichi Kinami, Toshio Ohnishi, Naohiko Nakamura, Zhi Yong Jiang, Takashi Miyata, Hideto Fujita, Hiroyuki Takamura, Nobuhiko Ueda, Takeo Kosaka
Shinichi Kinami, Toshio Ohnishi, Naohiko Nakamura, Zhi Yong Jiang, Takashi Miyata, Hideto Fujita, Hiroyuki Takamura, Nobuhiko Ueda, Takeo Kosaka, Department of Surgical Oncology, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
Author contributions: Kinami S was responsible for the scientific context and writing of the manuscript; Kinami S and Oonishi T performed nodal harvesting; Nakamura N, Jiang ZY, Miyata T, Fujita H, Ueda N, Takamura H, and Kosaka T contributed to the literature review, data analysis, and drafting, editing, and critical revision of the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Kanazawa Medical University Hospital.
Informed consent statement: All patients provided written informed consent for surgery and the use of their data. Regarding data use in the retrospective study, the patients were given the opportunity to opt out of the study at any time.
Conflict-of-interest statement: The authors declare no conflicts of interest related to the publication of the study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shinichi Kinami, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan. kinami@kanazawa-med.ac.jp
Received: February 29, 2020
Peer-review started: February 29, 2020
First decision: April 7, 2020
Revised: April 13, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: June 27, 2020
Abstract
BACKGROUND

There is an increased need for accurate staging for gastric cancer treatment. Consequently, it is necessary to carefully examine all dissected lymph nodes for precise staging. Recently, the fat-dissociation method has been developed as a quick and accurate method for harvesting dissected lymph nodes of colorectal cancer cases.

AIM

To investigate the usefulness of the fat-dissociation method for harvesting dissected lymph nodes of gastric cancer cases.

METHODS

Fifty-six resected specimens from gastric cancer patients who underwent standard curative gastrectomy and lymph node dissection at our hospital were used. Group 2 lymph nodes were separated from each specimen, and the remaining adipose tissue containing the group 1 lymph nodes was used. Some resected specimens were subjected to the fat-dissociation method. One vial of Imofully® was dissolved in 50 mL of saline and injected into the tissue. The tissue was incubated for 1 h and the dissolved fat was removed. Subsequently, the nodes were identified, picked up with scissors, and mapped. The number of nodes in each lymphatic compartment and duration of lymph node harvest and mapping were compared.

RESULTS

The fat-dissociation method was used for 24 samples, while the conventional dissection method was used for 32 samples. The total number of harvested lymph nodes was 45.9 in the fat dissociation group and 44.3 in the control group, and there was no significant difference between the two groups. There were also no significant differences in the number of lymph nodes between the two groups based on a comparison of the lymphatic compartments. However, the total median duration of the fat-dissociation method was 38.2 min, reflecting a reduced duration of approximately 60 min compared to the control group.

CONCLUSION

Based on our results, the fat-dissociation method is effective in shortening the duration of lymph node harvest in gastric cancer surgery.

Keywords: Gastric cancer, Lymph node dissection, Staging, Lymph node mapping, Fat-dissociation method, Efficacy

Core tip: Accurate examination of dissected lymph nodes is important for precise staging in gastric cancer treatment. We investigated the usefulness of the fat-dissociation method for lymph node harvest in gastric cancer. We used the fat-dissociation method on 24 resected specimens from patients with gastric cancer who underwent standard curative gastrectomy and lymph node dissection at our hospital, while the conventional method was used on 32 specimens. There were no differences in the numbers of harvested lymph nodes between these two groups; however, there was a 60 min reduction in the total median duration of the procedure when using the fat-dissociation method.