Predicting lymph node metastases in early gastric cancer: radical resection or organ-sparing therapy?

Novotny, Alexander; Schuhmacher, Christoph

doi:10.1007/s10120-008-0479-2

Cited by 11 publications

(11 citation statements)

References 15 publications

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“…In patients with gastric cancer without evidence of distant metastases, the main factor that determines the extent of the surgical procedure is the possibility of lymph node metastasis 1 . These are also the main prognostic factor in EGC, especially when one considers that metastasis to other sites are very rare 13 .…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

“…However, the degree of tumor penetration of the gastric wall is just one of the factors determining the risk of secondary lymph node implants. Other important factors are the macroscopic appearance of the lesion, tumor size, presence of lymphatic or vascular invasion and tumor differentiation grade 1,2,3,[5][6][7]13,15 . Early type III tumors, or ulcerated, or mixed and partially ulcerated, display higher rates of metastasis than other types of EGC, as attested in our sample.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

“…L ymph node metastasis in gastric cancer is frequent and early, and depends on many variables, amongst which the depth of invasion of the gastric wall, the degree of tumor differentiation and tumor size [1][2][3][4] . Thus, early tumors may have incidence of lymph node metastases ranging from 0%, when restricted to the mucosa, well differentiated and less than 2cm in size, to more than 30%, when reaching the submucosa, being poorly differentiated and having more than 2cm diameter 5,6 .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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Lymph node metastasis in early gastric cancer

Neto

Santos

Victer

et al. 2014

Rev. Col. Bras. Cir.

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the incidence of lymph node metastases in patients was very high and suggests that one should keep the radicality of resection in early gastric cancer, particularly in relation to D2 lymphadenectomy, recommended for advanced gastric cancer. Conservative resections, with lymphadenectomies smaller than D2, should be performed only in selected cases, well-studied as for the risk factors of lymph node metastasis. Despite the small number of cases did not permit to relate the rate of lymph node metastasis to the risk factors considered, we noted a strong tendency for the occurrence of these metastases in the poorly differentiated, type III, larger than 2 cm tumors, and in the Lauren diffuse types.

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Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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Lymph node metastasis in early gastric cancer

Neto

Santos

Victer

et al. 2014

Rev. Col. Bras. Cir.

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“…However, with the rate of lymph node metastasis reportedly close to 20% in cancer invading into the submucosal layer, endoscopic resection has its limitations. (1,2) Accordingly, for early gastric cancer invading beyond the middle of the submucosal layer (SM2) - itself a contraindication to endoscopic resection - open gastrectomy is required. (3,4)…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of the Pattern of Lymph Node Metastasis Depending on the Location of Gastric Cancer

et al. 2011

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PurposeWhen performing a laparoscopic assisted gastrectomy, a function-preserving gastrectomy is performed depending on the location of the primary gastric cancer. This study examined the incidence of lymph node metastasis by the lymph node station number by tumor location to determine the optimal extent of the lymph node dissection.Materials and MethodsThe subjects consisted of 1,510 patients diagnosed with gastric cancer who underwent a gastrectomy between 1996 and 2005. The patients were divided into three groups: upper, middle and lower third, depending on the location of the primary tumor. The lymph node metastasis patterns were analyzed in the total and early gastric cancer patients.ResultsIn all patients, lymph node station numbers 1, 2, 3, 7, 10 and 11 metastases were dominant in the cancer originating in the upper third, whereas station numbers 4, 5, 6 and 8 were dominant in the lower third. In early gastric cancer patients, the station number of lymph nodes with a metastasis did not show a significant difference in stage pT1a disease. On the other hand, a metastasis in lymph node station number 6 was dominant in stage pT1b disease that originated in the lower third of the stomach.ConclusionsWhen performing a laparoscopic-assisted gastrectomy for early gastric cancer, a limited lymphadenectomy is considered adequate during a function-preserving gastrectomy in mucosal (T1a) cancer. On the other hand, for submucosal (T1b) cancer, a number 6 node dissection should be performed when performing a pylorus preserving gastrectomy.

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“…I n patients with gastric adenocarcinoma, lymph node metastases are the main determinants of the extent of the surgical procedure, which consolidated broad gastrectomies, with D2 lymphadenectomies, as standard procedures in advanced gastric tumors 1 . In early gastric cancer (EGC), however, the incidence of lymph node metastases is around 20%, varying from 0% to 6.4% for those confined to the mucosa and from 2.2% to 24% when there is extension to the submucosa, these variations also depending on other factors, such as tumor grade, tumor size and presence or absence of angiolymphatic invasion [2][3][4][5][6][7][8][9][10][11] . Thus, the possibility of EGC metastases is greater when the tumor diameter exceeds 4cm in undifferentiated histological types and when there is angiolymphatic invasion.…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Ressecções gástricas menores com linfadenectomia modificada em câncer gástrico precoce com linfonodo sentinela negativo

Neto

Santos

Loja³

et al. 2012

Rev. Col. Bras. Cir.

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OBJETIVO: Estudar a pesquisa de linfonodo sentinela em câncer gástrico precoce como método diagnóstico de metástase ganglionar insuspeita, e que permita a realização, naqueles com gânglios negativos, de ressecções gástricas menores, com linfadenectomia limitada. MÉTODOS: Foram avaliados sete pacientes portadores de câncer gástrico precoce, tratados no Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, no período de setembro de 2008 a maio de 2011, e submetidos à pesquisa de linfonodo sentinela, realizada através da injeção endoscópica, peritumoral, transoperatória, do corante azul patente. RESULTADOS: Foram encontrados, em média, três linfonodos sentinelas por paciente. A biópsia por congelação destes linfonodos foi negativa para metástases, o que permitiu a realização de ressecção gástrica atípica em três casos e antrectomia com reconstrução a BI em quatro. A linfadenectomia realizada foi a D1 modificada. Não houve mortalidade operatória. O tempo de acompanhamento pós-operatório variou de cinco a 37 meses, sem evidências de recidivas. Uma paciente apresentou um segundo tumor precoce 13 meses depois da primeira cirurgia e foi submetida à gastrectomia total. CONCLUSÃO: A pesquisa de linfonodo sentinela em câncer gástrico precoce, nos sete pacientes estudados, mostrou-se um método eficaz para a avaliação de metástases ganglionares e permitiu a realização de ressecções gástricas menores e linfadenectomias limitadas. Estes procedimentos de menor porte diminuem o risco de complicações pós-operatórias, mantendo, por outro lado, a radicalidade oncológica que se exige no tratamento do câncer gástrico.

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Predicting lymph node metastases in early gastric cancer: radical resection or organ-sparing therapy?

Cited by 11 publications

References 15 publications

Lymph node metastasis in early gastric cancer

Lymph node metastasis in early gastric cancer

Clinical Significance of the Pattern of Lymph Node Metastasis Depending on the Location of Gastric Cancer

Ressecções gástricas menores com linfadenectomia modificada em câncer gástrico precoce com linfonodo sentinela negativo

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