Effect of total number of harvested lymph nodes on survival outcomes after curative resection for gastric adenocarcinoma: findings from an eastern high-volume gastric cancer center

Macalindong, Shiela S.; Kim, Kwang Hee; Nam, Byung–Ho; Ryu, Keun Won; Kubo, Norihito; Kim, Ja Yeon; Eom, Bang Wool; Yoon, Hong Man; Kook, Myeong–Cherl; Choi, Il Ju; Kim, Young Woo

doi:10.1186/s12885-017-3872-6

Cited by 51 publications

(33 citation statements)

References 42 publications

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“…Most of the parameters enrolled in the nal model emphasize the importance of complete elimination of the tumor. First, for the number of exLNs, according to the 8th edition of the AJCC staging manual, the retrieval of at least 16 lymph nodes is the minimal requirement for lymph node dissection (20), but there is growing evidence that increasing the number of harvested lymph nodes signi cantly improves survival (21)(22)(23)(24)(25)(26)(27)(28) , which is in accordance with our ndings. Increased exLNs indicate a more extended lymph node dissection and more precise staging.…”

Section: Discussionsupporting

confidence: 87%

Nomogram for predicting survival in advanced gastric cancer after neoadjuvant chemotherapy and radical surgery

Chen

Liú

Xiao

et al. 2020

Preprint

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BACKGROUND Neoadjuvant chemotherapy (NAC) with subsequent radical surgery has become a popular treatment modality for advanced gastric cancer (AGC) worldwide. However, the survival benefit is still controversial, and prognostic factors remain undetermined. AIM To identify clinical parameters that are associated with the survival of AGC patients after NAC and radical surgery and to establish a nomogram integrating multiple factors to predict survival. METHODS We reviewed the medical profiles of 215 AGC patients who received NAC and radical resection, and clinical parameters concerning NAC, surgery, pathological findings, and adjuvant chemotherapy were analyzed using a Cox regression model to determine their impact on survival. Based on these factors, a nomogram was developed and validated. RESULTS The overall 1-year and 3-year survival rates were 85.8% and 55.6%, respectively. Younger age (< 60 years old), increased examined lymph nodes (exLNs), successful R0 resection, achievement of pathological complete response (pCR), and acceptance of adjuvant chemotherapy were positive predictors of survival. The concordance statistic of the established nomogram was 0.785. The model showed an ideal calibration following internal bootstrap validation. CONCLUSION A nomogram predicting survival after NAC and surgery was established. Since this nomogram exhibited satisfactory and stable predictive power, it can be inferred that this it is a practical tool for predicting AGC patient survival after NAC and radical surgery.

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Section: Discussionsupporting

confidence: 87%

Nomogram for predicting survival in advanced gastric cancer after neoadjuvant chemotherapy and radical surgery

Chen

Liú

Xiao

et al. 2020

Preprint

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“…In this study, the proportion of stage I was higher than in other Korean data [ 13 14 ]. This is probably due to short duration and limited institutions of enrollment.…”

Section: Discussioncontrasting

confidence: 74%

Early Detection is Important to Reduce the Economic Burden of Gastric Cancer

Kim

Lee

et al. 2018

J Gastric Cancer

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PurposeEarly detection of gastric cancer is important to improve prognosis. Early detection enables local treatment, such as endoscopic submucosal dissection (ESD). Therefore, we investigated whether early detection of gastric cancer could reduce healthcare costs by comparison according to stage and treatment modalities.Materials and MethodsMedical care costs were investigated according to tumor stage and initial treatment modality in 1,188 patients newly diagnosed with gastric cancer at 7 medical institutions from December 2011 to June 2012. Total medical care costs during the first-year after diagnosis (total first-year costs) were examined, including the costs of initial treatment, post-initial treatment, and inpatient and outpatient visits.ResultsStage I (75.3%) was the most common cancer stage. ESD was the second most common treatment following surgery. Total first-year costs increased significantly from stages I to IV. The costs of initial treatment and post-initial treatment were lowest in patients with stage I cancer. Among patients with stage I cancer, total first-year costs were significantly lower when treated by ESD; in particular, initial ESD treatment costs were much lower than others.ConclusionsThe cost of healthcare has increased significantly with increasing cancer stages. ESD can greatly reduce medical care costs of gastric cancer. Thus, early detection of gastric cancer is important to reduce healthcare costs.

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“…Half of lymph node metastases in gastric cancer are microscopic peripheral-type metastases[ 23 , 24 ]. There are many reports that an increased number of harvested lymph nodes is associated with a better prognosis[ 19 , 25 - 27 ]. This is thought to reflect increased accuracy due to the increased number of nodes being examined.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the fat-dissociation method for nodal harvesting in gastric cancer

Kinami¹,

Ohnishi²,

Nakamura³

et al. 2020

WJGS

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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.

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Effect of total number of harvested lymph nodes on survival outcomes after curative resection for gastric adenocarcinoma: findings from an eastern high-volume gastric cancer center

Cited by 51 publications

References 42 publications

Nomogram for predicting survival in advanced gastric cancer after neoadjuvant chemotherapy and radical surgery

Nomogram for predicting survival in advanced gastric cancer after neoadjuvant chemotherapy and radical surgery

Early Detection is Important to Reduce the Economic Burden of Gastric Cancer

Efficacy of the fat-dissociation method for nodal harvesting in gastric cancer

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