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
ARTICLE HIGHLIGHTS
Research background

In gastric cancer surgery, the status of lymph node metastasis affects the prognosis after curative surgery and is an important factor in determining whether adjuvant therapy should be administered. Therefore, it is necessary to accurately examine dissected lymph nodes. However, lymph node harvest is not emphasized in gastric cancer surgery.

Research motivation

Recently, the fat-dissociation method has been developed as a quick and accurate method for harvesting dissected lymph nodes. This is a method of dissolving the fat of the mesentery with a specific reagent, which results in improved visibility of the lymph nodes and facilitates their harvest.

Research objectives

This study aimed to investigate the usefulness of the fat-dissociation method for harvesting dissected lymph nodes of gastric cancer cases.

Research methods

Fifty-six resected specimens from gastric cancer patients who underwent standard curative gastrectomy and lymph node dissection 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 saline and injected into the tissue. The tissue was incubated, and the dissolved fat was removed. The number of nodes in each lymphatic compartment and duration of lymph node harvest were compared.

Research 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 numbers 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.

Research conclusions

The fat-dissociation method is effective in shortening the duration of lymph node harvest in gastric cancer surgery. Although difficult to quantify, the fat-dissociation method may reduce the labor and difficulty of the harvest procedure. However, if the surgeon is sufficiently skilled, the fat-dissociation method may not result in improved accuracy.

Research perspectives

The adoption of the fat-dissociation method should occur based on the skills and workload of the surgeons performing the harvest procedure, as well as the cost of the reagents required to perform the fat-dissociation method.