Comparison of lymph node number and prognosis in gastric cancer patients with perigastric lymph nodes retrieved by surgeons and pathologists

Abstract

ObjectiveTo compare the numbers of positive and total lymph nodes and prognosis in gastric cancer patients whose perigastric lymph node retrieval was performed by surgeons and pathologists.MethodsWe conducted a retrospective analysis of clinical and follow-up data from 1, 056 patients who underwent gastric cancer D2 radical lymph node resection between January 2008 and December 2010 in the Gastrointestinal Surgery Department of Yantai Yuhuangding Hospital. The follow-up ended in December 2015. Patients were divided into two groups according to the specialty of physicians who performed the postoperative perigastric lymph node retrieval: the surgeon group (475 cases) and the pathologist group (581 cases). The numbers of positive and total perigastric lymph nodes and the 3- and 5-year survival were compared between gastric cancer patients in the two groups overall and stratified by TNM stage (the 7th Edition of the American Joint Committee on Cancer).ResultsOverall, the numbers of positive and total lymph nodes were significantly higher in the surgeon group than in the pathologist group (6.53±4.07 vs. 4.09±3.70, P=0.021; 29.64±11.50 vs. 20.71±8.56, P<0.001). Further analysis showed that the total number of lymph nodes in stage I patients (19.40±9.62 vs. 15.45±8.59, P=0.011) and the numbers of positive and total lymph nodes in stage II (1.38±1.08 vs. 0.87±1.55, P=0.031; 25.35±10.80 vs. 16.75±8.56, P<0.001) and stage III patients (8.11±6.91 vs. 6.66±5.12, P=0.026; 32.34±12.55 vs. 25.45±8.31, P<0.001) were significantly higher in the surgeon group than in the pathologist group. The survival analysis showed that the 3- and 5-year survival of stage II and III patients was significantly higher in the surgeon group than in the pathologist group (82.0% vs. 73.1%, 69.5% vs. 61.2%, P=0.038; 49.2% vs. 38.9%, 36.3% vs. 28.0%; P=0.045).ConclusionsCompared with retrieval performed by pathologists, postoperative perigastric lymph node retrieval performed by surgeons was associated with significant increase in the total lymph node number of stage I patients, the numbers of positive and total lymph nodes of stage II and III patients, and the survival of stage II and stage III gastric cancer patients.

The Methods of Lymph Node Examination Make a Difference to Node Staging and Detection of N3b Node Status for Gastric Cancer

“…LN retrieval from the operation specimen not by pathologists but by the surgicopathologic team (who have been trained with anatomical and surgical learning programs) can obtain a better three-dimensional view of the anatomical relationships. Furthermore, previous studies have demonstrated that despite some anatomical variability in the distribution of LNs, LN retrieval by the surgicopathologic team, rather than by the pathologists, could lead to more RLNs, which is helpful for standardizing the nodal status assessment (9,21). Consistently, in our trial, the number of RLNs in the surgicopathologist group was significantly higher than that in the pathologist group (18.8 ± 11.5 vs. 53.8 ± 20.9, p < 0.001); the surgicopathologist group also detected a greater number of MLNs (3.9 ± 5.7 vs. 5.6 ± 9.8, p < 0.001).…”

Number of retrieved lymph nodes is an independent prognostic factor after total gastrectomy for patients with stage III gastric cancer: propensity score matching analysis of a multi-institution dataset

“…The number of RNLs is influenced by the extent of lymphadenectomy, the surgeon's enthusiasm to pathologically examine more LNs, the surgeon's skill, surgical considerations (such as fat volume), and the innate number of LNs in each patient [9][10][11]18]. Depending on the surgeon's skill, LNs may not be completely excised, may be destroyed, or both, which may affect the number of RLNs.…”

“…For patients with RLNs < 40, careful and intensive follow-up should be performed, because they are at high risk of disease recurrence. The UICC guidelines recommend radiotherapy and chemotherapy to prevent recurrence in patients with > 16 harvested LNs [11]. Postoperative adjuvant chemoradiation therapy may, therefore, serve as a preferred option to control locoregional recurrence and suitable for evaluating patients with RLNs < 40 after total gastrectomy, though this is not been proven to confer a survival benefit upon patients from Asian countries [28][29][30].…”

“…Before analyzing the data, we classified these patients according to the TNM classification [12] and the Japanese Gastric Cancer Treatment Guideline [7]. We selected 1103 patients for analysis according to the inclusion criteria as follows: no preoperative treatment, R0 gastrectomy with systematic lymphadenectomy performed according to the Japanese Gastric Cancer Treatment Guideline [7], pathological stage II-III gastric cancer according to the TNM classification [11], and sufficient data for analysis ( Fig. 1a).…”

“…Although systematic lymphadenectomy is considered a pivotal strategy for macroscopic tumor clearance in advanced gastric cancer, there are certain differences in the numbers of retrieved LNs (RLNs), even if surgery is performed as recommended by the Japanese Gastric Cancer Treatment Guideline [7][8][9]. The number of RLNs is influenced by factors such as the extent of lymphadenectomy and gastrectomy, intra-abdominal fat volume, innate number of nodes in each patient, and a surgeon's enthusiasm for harvesting more nodes [10,11]. In the Japanese Classification of Gastric Carcinoma Carcinoma, 15th Edition [6] and the TNM Classification of Malignant Tumors, 8th Edition [12] (TNM), at least 16 RLNs are recommended for appropriate staging; however, information is not available that indicate prognostic risks if an unsatisfactory number of RLNs are obtained [7,12].…”