Factors Influencing Lymph Node Recovery from the Operative Specimen after Gastrectomy for Gastric Adenocarcinoma

Schoenleber, Scott J.; Schnelldorfer, Thomas; Wood, Christina M.; Qin, Rui; Sarr, Michael G.; Donohue, John H.

doi:10.1007/s11605-009-0886-7

Cited by 23 publications

(11 citation statements)

References 13 publications

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“…These results indicate that both the French study and the current study do not know exactly which lymphadenectomy was actually performed by the surgeons. In addition to these uncertainties, there might be variation in lymphadenectomy between surgeons, variation in the submission of specimens ( en bloc or in separate containers),25 and variation in lymph node retrieval by pathologists,26 all of which may influence the final LNY. All these factors combined imply that caution should be taken in drawing conclusions on the extent of lymphadenectomy, based solely on counting lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

A High Lymph Node Yield is Associated with Prolonged Survival in Elderly Patients Undergoing Curative Gastrectomy for Cancer: A Dutch Population-Based Cohort Study

et al. 2017

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PurposeThe aim of this study was to evaluate the influence of lymph node yield (LNY) on postoperative mortality and overall survival in elderly patients with gastric cancer.MethodsThis population-based study included data from The Netherlands Cancer Registry of patients who underwent curative gastrectomy for adenocarcinoma between 2006 and 2014. Patients were divided into two groups based on age (<75 years, young; ≥75 years, elderly). LNY was analyzed as both a categorical variable (low, <15 nodes; intermediate, 15–25 nodes; high, >25 nodes), and a discrete variable. Multivariable analysis was used to evaluate the influence of LNY on 30- and 90-day mortality, as well as overall survival.ResultsA total of 3764 patients were included in the study; 2387 (63%) were classified as ‘young’, and 1377 (37%) were classified as ‘elderly’. The median LNY was 14 in the young group, compared with 11 in the elderly group (p < 0.001). In the elderly group, 851 (62%) patients had a low LNY, 333 (24%) had an intermediate LNY, and 174 (13%) had a high LNY. Multivariable analysis demonstrated that in the elderly patients, a higher LNY was associated with a prolonged overall survival (low: reference; intermediate: hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.62–0.88, p < 0.001; high: HR 0.59, 95% CI 0.45–0.78, p < 0.001), but not with 30-day (p = 0.940) and 90-day mortality (p = 0.573). For young patients, these results were comparable.ConclusionIn both young and elderly patients, a high LNY is associated with prolonged survival but not with an increase in postoperative mortality. Therefore, an extensive lymphadenectomy is the preferred strategy for all patients during gastrectomy in order to provide an optimal oncological result.

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Section: Discussionmentioning

confidence: 99%

A High Lymph Node Yield is Associated with Prolonged Survival in Elderly Patients Undergoing Curative Gastrectomy for Cancer: A Dutch Population-Based Cohort Study

et al. 2017

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“…Apart from type of gastric resection and of lymph node dissection, whose influence on the number of examined lymph nodes appears obvious, other independent variables in our study were age, pN and the single pathologist. A recent report from the Mayo Clinic showing similar numbers of examined lymph nodes per patient confirmed an independent role for the type of lymph node dissection and the pN status [27]; for the first time, it highlighted a significant role for the pathology technician more than for the pathologist. In our clinical practice, the pathology technician simply has no role as lymph node retrieval on the formalin-fixed specimen is performed by the pathologist himself.…”

Section: Discussionmentioning

confidence: 81%

Lymph node retrieval and examination during the implementation of extended lymph node dissection for gastric cancer in a non-specialized western institution

et al. 2010

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The optimal degree of lymph node dissection for gastric cancer is still matter of debate. Particularly, there are serious doubts about the reproducibility of extended lymph node dissection in western surgical units, and no studies to date have investigated factors influencing lymph node retrieval and examination during the learning curve. Univariate and multivariate retrospective analysis of 21 variables were carried out on a prospective series of 313 consecutive resections for gastric cancer performed by ten different surgeons, with lymph node retrieval and analysis performed by ten different pathologists. Endpoints were number of examined lymph nodes per patient, number of cases with inadequate nodal staging (<15 examined lymph nodes) and lymph node ratio (calculated as the absolute ratio between the number of metastatic and the number of examined lymph nodes). The number of examined lymph nodes per patient (mean ± SD 28.3 ± 14.1, median 26, range 2-78) was independently influenced by age, pN status, the type of gastric resection, the degree of lymph node dissection and single pathologist. There were 47 cases (15.0%) with incomplete nodal staging that was independently determined by the degree of lymph node dissection and by the pathologist. Lymph node ratio was independently influenced by the number of metastatic lymph nodes, the disease stage and by the histological subtype of the tumor. The role of an experienced or dedicated pathologist should not be underevaluated in western series when dealing with lymph node retrieval and examination. Lymph node ratio appeared not to be significantly influenced by the number of examined lymph nodes, being independently influenced only by the number of metastatic lymph nodes, the disease stage and by the histological subtype of the tumor. It could be therefore tested as a prognostic factor limiting the stage-migration phenomenon induced by extended lymph node dissection.

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“…For example, Schoenleber et al reviewed 99 consecutive patients who underwent gastrectomy for gastric adenocarcinoma to determine factors that affect lymph node counts [16]. The surgeon (P=0.16) did not affect lymph node counts; however, the senior pathologist (P=0.03) and, more significantly, the pathology technician (P<0.001) had the most significant influence on lymph node counts on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

702 Ex-Vivo Lymphadenectomy During Gastrectomy for Adenocarcinoma Optimizes Lymph Node Yield

et al. 2015

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Factors Influencing Lymph Node Recovery from the Operative Specimen after Gastrectomy for Gastric Adenocarcinoma

Cited by 23 publications

References 13 publications

A High Lymph Node Yield is Associated with Prolonged Survival in Elderly Patients Undergoing Curative Gastrectomy for Cancer: A Dutch Population-Based Cohort Study

A High Lymph Node Yield is Associated with Prolonged Survival in Elderly Patients Undergoing Curative Gastrectomy for Cancer: A Dutch Population-Based Cohort Study

Lymph node retrieval and examination during the implementation of extended lymph node dissection for gastric cancer in a non-specialized western institution

702 Ex-Vivo Lymphadenectomy During Gastrectomy for Adenocarcinoma Optimizes Lymph Node Yield

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