Benefits of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases

Siewert, J. R.; Kestlmeier, R; Busch, Raymonde; Böttcher, K.; Roder, J. D.; Müller, Johannes; Fellbaum, Christian; Höfler, Heinz

doi:10.1002/bjs.1800830836

Cited by 244 publications

(143 citation statements)

References 14 publications

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“…Therefore, radical lymphadenectomy for gastric cancer has become a standard procedure, resulting in the long-term survival of patients with lymph node metastasis (Maehara et al, 1992). Nevertheless, several authors have reported that complete resection with radical lymphadenectomy that led to a nodenegative (pN0) final diagnosis according to routine histological haematoxylin -eosin (HE) staining did not prevent recurrence (Maehara et al, 1996;Siewert et al, 1996;Ishida et al, 1997). The key causative factor of recurrent gastric cancer is lymph node micrometastasis.…”

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confidence: 99%

Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer

et al. 2005

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The monoclonal antibody D2-40 is a specific lymphatic endothelial markers and D2-40 staining have been applicable to evaluate lymphatic invasion in various malignant neoplasms. In the present study, we investigated lymph node micrometastasis determined by immunohistochemistry (IHC) and reverse transcription -polymerase chain reaction (RT -PCR) in all dissected lymph nodes obtained from 80 patients with node-negative gastric cancer, and analysed the relationship between micrometastasis and clinicopathological findings including lymphatic invasion of the resected primary tumour using D2-40 immunohistochemical staining. The incidence of micrometastasis determined by IHC and RT -PCR was 11.3% (nine out of 80) and 31.3% (25 out of 80), respectively. Although haematoxylin -eosin (HE) staining revealed lymphatic invasion in 11.3% (nine out of 80) of patients, D2-40 staining uncovered new invasion in 23.8% (19 out of 80) of patients. In the diagnosis of HE and D2-40 staining, the incidence of micrometastasis was significantly higher in patients with lymphatic invasion than in those without lymphatic invasion (P ¼ 0.0150 and Po0.0001, respectively). Micrometastasis correlated more closely with D2-40 than with HE staining. We demonstrated a high incidence of micrometastasis and lymphatic invasion and a correlation between them even in pN0 gastric cancer. When planning less invasive treatment, the presence of such occult cancer cells should be considered.

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confidence: 99%

Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer

et al. 2005

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“…Furthermore, gastrectomy with D2 lymphadenectomy can be performed with a low complication rate and was found to significantly improve the 5-year survival rate. Siewert et al (1996) claimed that D2 lymphadenectomy could improve prognosis in patients without lymph node metastases. The reason for this improvement is that the micrometastases found in approximately 10% of the cases can only be detected with immunohistochemical techniques that are not routinely used.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

Wang¹,

Ma²,

Zhang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Early gastric cancer (EGC) is well accepted as having a favorable prognosis, but some patients experience an ominous outcome after curative resection. This study was aimed at evaluating predictive factors associated with prognosis of D2 gastrectomies in patients with early gastric cancer. Materials and Methods: A total of 518 patients with early gastric cancer who underwent D2 gastrectomies were reviewed in this study. The clinicopathological features and surgical outcomes were analyzed. The survival rate was estimated using the Kaplan-Meier method and compared by log rank test. Prognostic factors were analyzed using a multivariate Cox proportional hazards model. Results: The 5-year survival rate was 90.3%. Tumor infiltration, lymph node metastasis and lymphovascular invasion were significant prognostic factors for survival. Gender, age, tumor size, tumor location, macroscopic type and histological type were not significant prognostic factors. Multivariate analysis indicated that lymph node metastasis was an independent poor prognosis factor. Conclusions: Early gastric cancers with lymph node metastasis have a relatively poor prognosis after standard surgery. Even after curative resection, patients with EGC with positive lymph nodes should be closely followed and be considered as candidates for comprehensive therapies.

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“…There are others definitions for micrometastasis as malignant cells cluster smaller than 2 mm in diameter 32 , smaller than 0.5 mm 27 and 5 or less cells 15 , all of them with stromal reaction such as granulation or desmoplastic tissue. In the other hand microinvolvement can be described as individual tumor cells without stromal reaction 32 .…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of occult lymph node micrometastasis in gastric cancer: a histochemical and immunohistochemical study based on 1997 UICC TNM and 1998 JGCA classifications

Dell'Aquila

Lopasso

Falzoni

et al. 2008

ABCD, arq. bras. cir. dig.

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BACKGROUND: Micrometastasis is a single or a cluster of malignant cells inside the lymph node that are not detected by routine histopathological sections. Micrometastasis is related to poorer prognosis in many gastric cancer studies the real significance of these cells is still controversial. AIM: To evaluate if lymph node micrometastasis is a significant independent prognostic factor and important risk factor for recurrence in gastric cancer. METHODS: A total of 1290 lymph nodes from 28 patients with gastric cancer, since 1998 until 2003, treated by radical resection (D2 and modified D3 lymphadenectomies) were studied. Three sections per lymph node were stained by Hematoxilin-Eosin, histochemical (AB-PAS) and immunohistochemical (AE1-AE3) techniques. Kaplan-Meier's survival curves and Log-rank/Cox tests were used in order to compares lymph node micrometastasis positivity, depth (pT) and location of tumor in gastric wall, histologic type, lymphatic, vascular and perineural invasion, lymph node status (pN) and stage. RESULTS: There were worse prognosis and recurrence in patients with positive lymph node micrometastasis related to vascular and perineural invasions, advanced lymph node status and advanced stages. CONCLUSION: Lymph node micrometastasis seems to be a significant independent prognostic factor and important risk factor for recurrence in gastric cancer, in a context of radical D2 lymphadenectomy

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Benefits of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases

Cited by 244 publications

References 14 publications

Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer

Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer

Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

Prognostic significance of occult lymph node micrometastasis in gastric cancer: a histochemical and immunohistochemical study based on 1997 UICC TNM and 1998 JGCA classifications

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