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

Abstract

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.

A new fat-dissociation method to detect lymph nodes in colorectal cancer: a prospective randomized study

“…In addition, our fat-dissociation solution at low concentration was commercialized as Imofully (Sysmex, Kobe, Japan). Similar to our study, it was reported that the results were excellent in short-term results such as the number of lymph nodes and the search time by using Imofully (Sysmex) 24,25 . It has been reported recently that molecular characterization of cancer based on gene expression is important for proper disease stratification 26 , and the appropriate drug treatment is selected according to specific mutations 2,9 .…”

Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis

“…In clinical practice, more than 15 lymph nodes are often targeted for harvesting (118). However, the actual number of affected lymph nodes is higher, and previous studies have reported that the number of lymph nodes harvested after D2 distal gastrectomy can exceed 40 (113,119,120). Many reports have suggested that a greater number of harvested lymph nodes is associated with better prognosis (121)(122)(123).…”

“…Gastric cancer has many regional lymph nodes, many of which are small, and metastases can occur even in these small lymph nodes (61,62), which makes harvesting the nodes difficult. However, until now, the accuracy of node harvesting has been neglected (113,114). Worldwide, harvested nodes are likely to be handled by pathologists.…”

“…Worldwide, harvested nodes are likely to be handled by pathologists. The "palpitation method" for discriminating lymph nodes is probably the most practiced method worldwide and can be performed by pathologists (113), but the number of lymph nodes is larger when examined by surgeons or at a specialized facility (115)(116)(117). In clinical practice, more than 15 lymph nodes are often targeted for harvesting (118).…”

How surgeon and pathologist cooperation may drive toward a more efficient nodes harvesting in gastric cancer surgery

“…In some non-specialized Western centers, it is generally achieved from formalin-fixed (FF) samples by pathologist during the grossing procedure; although this method is time-consuming, small LNs (1.0 mm) may still be missed [5]. Therefore, the hot question of how to accomplish a complete LNs harvesting still remains, as most of the procedures proposed and applied so far were often disappointing [6,7]. This results in the increasing needing of a standardized and easily applicable operative protocol.…”