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01-02-2014 | Gastrointestinal Oncology

Oncologic Safety of Pylorus-preserving Gastrectomy in the Aspect of Micrometastasis in Lymph Nodes at Stations 5 and 6

Authors: Baek-hui Kim, MD, PhD, Soon Won Hong, MD, PhD, Jong Won Kim, MD, PhD, Seung Ho Choi, MD, PhD, Sun Och Yoon, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2014

Abstract

Background

Pylorus-preserving gastrectomy (PPG) is a function-preserving gastrectomy for early gastric cancers (EGCs) that are preoperatively assessed as pN0 tumors and located in the middle portion of the stomach. In PPG, dissection of the lymph nodes at stations 5 and 6 is frequently incomplete, and this may be worrisome in terms of oncologic safety.

Methods

We examined lymph nodes collected from stations 5 and 6 from 196 patients who had undergone conventional distal gastrectomy (CDG) for EGC located in the middle portion of the stomach and from 24 patients who had undergone PPG.

Results

The average number of lymph nodes collected at station 5 was significantly lower with PPG than with CDG (0.08 vs. 1.32, respectively; P = 0.008). However, such a difference was not noted for station 6 nodes. The rate of macrometastasis was very low in all station 5 nodes (1 of 220, 0.45 %) and station 6 nodes (1 of 220, 0.45 %). Immunohistochemical analysis of cytokeratin in 109 cases of the CDG group and 21 cases of the PPG group showed that micrometastasis of single isolated tumor cell type was observed in only one station 6 lymph node of a patient who was initially diagnosed with pN0 EGC. There were no cases of micrometastasis in station 5 nodes.

Conclusions

The possibility of micrometastasis to station 5 and/or 6 lymph nodes may be negligible for EGC located in the middle portion of the stomach, and PPG thus might be the oncologically safe procedure when considering micrometastasis in remaining nodes in vivo at stations 5 and 6.

Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery. 1967;61:838–45.PubMed

Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer. 2007;10:167–72.PubMedCrossRef

Park do J, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008;32:1029–36.PubMedCrossRef

Shibata C, Shiiba KI, Funayama Y, et al. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg. 2004;28:857–61.PubMedCrossRef

Kong SH, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK. The safety of the dissection of lymph node stations 5 and 6 in pylorus-preserving gastrectomy. Ann Surg Oncol. 2009;16:3252–8.PubMedCrossRef

Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg. 2008;95:1131–5.PubMedCrossRef

Ikeguchi M, Hatada T, Yamamoto M, et al. Evaluation of a pylorus-preserving gastrectomy for patients preoperatively diagnosed with early gastric cancer located in the middle third of the stomach. Surg Today. 2010;40:228–33.PubMedCrossRef

Nitti D, Marchet A, Olivieri M, et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol. 2003;10:1077–85.PubMedCrossRef

10.

Catalano V, Labianca R, Beretta GD, Gatta G, de Braud F, Van Cutsem E. Gastric cancer. Crit Rev Oncol Hematol. 2009;71:127–64.PubMedCrossRef

11.

Edge SB, American Joint Committee on Cancer. AJCC cancer staging manual. 7th edition. New York: Springer; 2010.

12.

Aaltonen LA, Hamilton SR, World Health Organization, International Agency for Research on Cancer. Pathology and genetics of tumours of the digestive system. Oxford: IARC; 2000.

13.

Arigami T, Uenosono Y, Yanagita S, et al. Clinical significance of lymph node micrometastasis in gastric cancer. Ann Surg Oncol. 2013;20:515–21.PubMedCrossRef

14.

Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.

15.

Rosai J, Ackerman LV. Rosai and Ackerman’s surgical pathology. 10th edition. New York: Mosby; 2011.

16.

Cai J, Ikeguchi M, Maeta M, Kaibara N. Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer. Surgery. 2000;127:32–9.PubMedCrossRef

17.

Maehara Y, Oshiro T, Endo K, et al. Clinical significance of occult micrometastasis lymph nodes from patients with early gastric cancer who died of recurrence. Surgery. 1996;119:397–402.PubMedCrossRef

18.

Morgagni P, Saragoni L, Folli S, et al. Lymph node micrometastases in patients with early gastric cancer: experience with 139 patients. Ann Surg Oncol. 2001;8:170–4.PubMedCrossRef

19.

Choi HJ, Kim YK, Kim YH, Kim SS, Hong SH. Occurrence and prognostic implications of micrometastases in lymph nodes from patients with submucosal gastric carcinoma. Ann Surg Oncol. 2002;9:13–9.PubMedCrossRef

20.

Morgagni P, Saragoni L, Scarpi E, et al. Lymph node micrometastases in early gastric cancer and their impact on prognosis. World J Surg. 2003;27:558–61.PubMedCrossRef

21.

Miyake K, Seshimo A, Kameoka S. Assessment of lymph node micrometastasis in early gastric cancer in relation to sentinel nodes. Gastric Cancer. 2006;9:197–202.PubMedCrossRef

22.

Cao L, Hu X, Zhang Y, Huang G. Adverse prognosis of clustered-cell versus single-cell micrometastases in pN0 early gastric cancer. J Surg Oncol. 2011;103:53–6.PubMedCrossRef

23.

Han KB, Jang YJ, Kim JH, et al. Clinical significance of the pattern of lymph node metastasis depending on the location of gastric cancer. J Gastric Cancer. 2011;11:86–93.PubMedCentralPubMedCrossRef

24.

Pantel K, Brakenhoff RH, Brandt B. Detection, clinical relevance and specific biological properties of disseminating tumour cells. Nat Rev Cancer. 2008;8:329–40.PubMedCrossRef

25.

Weaver DL, Ashikaga T, Krag DN, et al. Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364:412–21.PubMedCentralPubMedCrossRef

26.

Kunisaki C, Akiyama H, Nomura M, et al. Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol. 2006;13:363–9.PubMedCrossRef

27.

Nomura S, Kaminishi M. Surgical treatment of early gastric cancer. Dig Surg. 2007;24:96–100.PubMedCrossRef

Title: Oncologic Safety of Pylorus-preserving Gastrectomy in the Aspect of Micrometastasis in Lymph Nodes at Stations 5 and 6
Authors: Baek-hui Kim, MD, PhD
Soon Won Hong, MD, PhD
Jong Won Kim, MD, PhD
Seung Ho Choi, MD, PhD
Sun Och Yoon, MD, PhD
Publication date: 01-02-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 2/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-3252-7

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Oncologic Safety of Pylorus-preserving Gastrectomy in the Aspect of Micrometastasis in Lymph Nodes at Stations 5 and 6

Abstract

Background

Methods

Results

Conclusions

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Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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