Prevalence and Topography of Lymph Node Metastases in Early Esophageal and Gastric Cancer

Gertler, Ralf; Stein, Hubert J.; Schuster, Tibor; Rondak, Ina-Christine; Höfler, Heinz; Feith, Marcus

doi:10.1097/sla.0000000000000239

Cited by 63 publications

(68 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Degiuli et al [37] found 17/189 (9 %) patients with three or more positive lymph nodes in their randomised controlled trial of lymphadenectomy had early gastric cancer. Other surgeons have reported positive N3 lymph nodes in patients labelled as having early gastric cancer [38,39]. If lymph node status was known, there would be significant change in the management of these patients.…”

Section: Early Gastric Cancer: the Definitions And Issuesmentioning

confidence: 97%

“…Given that the indications for therapeutic endoscopy do not take into account lymph node status, it appears reasonable that, at the very least, lymphovascular invasion be considered. Two recent approaches to predicting lymph node metastases have taken lymphovascular invasion into account [38,80]. Shida et al [80] looked to predict lymph node metastases [38] proposed a nomogram to predict the risk of lymph node metastases in early gastric and oesophageal cancers using multiple factors, including age, tumour depth and differentiation, tumour multi-focality and lymphovascular invasion.…”

Section: Redefining Early Gastric Cancer: the Way Forwardmentioning

confidence: 99%

“…Two recent approaches to predicting lymph node metastases have taken lymphovascular invasion into account [38,80]. Shida et al [80] looked to predict lymph node metastases [38] proposed a nomogram to predict the risk of lymph node metastases in early gastric and oesophageal cancers using multiple factors, including age, tumour depth and differentiation, tumour multi-focality and lymphovascular invasion. They internally validated the nomogram using a tenfold cross-validation in which they divided the original data set randomly into 10 independent subsets of approximately the same size.…”

Section: Redefining Early Gastric Cancer: the Way Forwardmentioning

confidence: 99%

See 2 more Smart Citations

Redefining early gastric cancer

Barreto

Windsor

2015

Surg Endosc

View full text Add to dashboard Cite

Background The problem is that current definitions of early gastric cancer allow the inclusion of regional lymph node metastases. The increasing use of endoscopic submucosal dissection to treat early gastric cancer is a concern because regional lymph nodes are not addressed. The aim of the study was thus to critically evaluate current evidence with regard to tumour-specific factors associated with lymph node metastases in ''early gastric cancer'' to develop a more precise definition and improve clinical management. Methods A systematic and comprehensive search of major reference databases (MEDLINE, EMBASE, PubMed and the Cochrane Library) was undertaken using a combination of text words All available publications that described tumour-related factors associated with lymph node metastases in early gastric cancer were included. ResultsThe initial search yielded 1494 studies, of which 42 studies were included in the final analysis. Over time, the definition of early gastric cancer has broadened and the indications for endoscopic treatment have widened. The mean frequency of lymph node metastases increased on the basis of depth of infiltration (mucosa 6 % vs. submucosa 28 %), presence of lymphovascular invasion (absence 9 % vs. presence 53 %), tumour differentiation (differentiated 13 % vs. undifferentiated 34 %) and macroscopic type (elevated 13 % vs. flat 26 %) and tumour diameter (B2 cm 8 % vs.[2 cm 25 %). Conclusion There is a need to re-examine the diagnosis and staging of early gastric cancer to ensure that patients with one or more identifiable risk factor for lymph node metastases are not denied appropriate chemotherapy and surgical resection.Gastric cancer is the fourth most common cancer in the world [1]. With an overall 5-year survival rate of \20 % [2], gastric cancer accounts for 10 % of cancer-related deaths worldwide [3,4]. The main reason for the dismal outcome associated with gastric cancer stems from the fact that while curative surgery holds the only hope for cure [5], patients often present at a late stage of the disease [2, 6] when performance of this curative surgery is not feasible or warranted. Buried in these dismal statistics lies a subset of patients with so-called early gastric cancer who have reported 5-year survival rates approaching 99 % [7-9]. Early gastric cancer is more commonly reported in Japan [10,11] owing to widespread screening programmes and a greater awareness of gastric cancer owing to the high incidence of disease. However, the incidence appears to be rising in other parts of the world, as well [7,12,13].

show abstract

Section: Early Gastric Cancer: the Definitions And Issuesmentioning

confidence: 97%

Section: Redefining Early Gastric Cancer: the Way Forwardmentioning

confidence: 99%

Section: Redefining Early Gastric Cancer: the Way Forwardmentioning

confidence: 99%

See 1 more Smart Citation

Redefining early gastric cancer

Barreto

Windsor

2015

Surg Endosc

View full text Add to dashboard Cite

show abstract

“…In association with T stage, LN involvement can be found in 15% of patients with carcinoma confined to the mucosa, whereas LN metastases were detected in 23.4%, 48.2%, and 69.8% of patients with carcinoma invading the submucosa, muscularis propria and serous layer, respectively [14] Gertler et al [15] showed that not only infiltration of the submucosa but also lymphatic vessel invasion, multifocal tumor growth, younger patient age and poor tumor differentiation were associated with nodal disease. Besides T stage, LN involvement can also be influenced by tumor size.…”

Section: Ln Involvementmentioning

confidence: 99%

Clinical significance of lymphadenectomy in patients with gastric cancer

Tóth

Plósz

Török

2016

WJGO

View full text Add to dashboard Cite

Approximately thirty percent of patients with gastric cancer undergo an avoidable lymph node dissection with a higher rate of postoperative complication. Comparing the D1 and D2 dissections, it was found that there is a significant difference in morbidity, favoured D1 dissection without any difference in overall survival. Subgroup analysis of patients with T3 tumor shows a survival difference favoring D2 lymphadenectomy, and there is a better gastric cancer-related death and non-statistically significant improvement of survival for node-positive disease in patients with D2 dissection. However, the extended lymphadenectomy could improve stage-specific survival owing to the stage migration phenomenon. The deployment of centralization and application of national guidelines could improve the surgical outcomes. The Japanese and European guidelines enclose the D2 lymphadenectomy as the gold standard in R0 resection. In the individualized, stageadapted gastric cancer surgery the Maruyama computer program (MCP) can estimate lymph node involvement preoperatively with high accuracy and in addition the Maruyama Index less than 5 has a better impact on survival, than D-level guided surgery. For these reasons, the preoperative application of MCP is recommended routinely, with an aim to perform "low Maruyama Index surgery". The sentinel lymph node biopsy (SNB) may decrease the number of redundant lymphadenectomy intraoperatively with a high detection rate (93.7%) and an accuracy of 92%. More accurate stage-adapted surgery could be performed using the MCP and SNB in parallel fashion in gastric cancer.

show abstract

“…There is a very high prevalence of affected LN in cases of LVI, poor differentiation [35][36][37][38] and in the diffuse type of adenocarcinoma with a size of >2 cm [39][40][41]. In the case of verified LN metastasis, surgery and chemotherapy in the adjuvant setting represent the treatment of choice [42].…”

Section: Early Gastric Lesionsmentioning

confidence: 99%

A Surgeon’s Role in the Management of Early Esophageal, EGJ and Gastric Lesions

Simić

Skrobić

Peško

2019

Dig Dis

View full text Add to dashboard Cite

Background: Endoscopic mucosal resection and submucosal dissection (ESD) are indicated in a majority of mucosal esophageal, esophagogastric junction and gastric cancers (GC), and selected cases of submucosal cancers as well. Summary: The presence of lymph node metastases in early esophageal cancer (EC) has been proven in up to 50% of patients with sm3 cancers treated with surgical resection, and up to 18.5 and 30.5% in sm1 and sm2 cancer respectively. The presence of lymphovascular invasion (LVI), tumor depth >500 μm and poor tumor differentiation seem to be a common predictor of worse outcomes in literature reports. In case of early esophagogastric junction cancer (EGJC) these predictors include LVI, tumor size >3 cm, Barrett’s origin of the tumor and ulcerative tumor appearance. Extended indications for ESD in early GC are already adopted in high volume centers with high success rates (up to 98%). Jet, positive resection margins after ESD, LVI and poor tumor differentiation carry high metastatic potential, therefore advocating surgery. Limited resections and cooperative laparoscopic endoscopic approach may be implemented in cases of early EGJC and GC. Key Messages: The presence of LVI, depth of submucosal invasion, and poor tumor differentiation in cases of early EC, EGJC, and GC favor surgical treatment despite improvements in endoscopic techniques.

show abstract

Prevalence and Topography of Lymph Node Metastases in Early Esophageal and Gastric Cancer

Abstract: Risk estimation for lymph node metastases should not be based on depth of tumor infiltration alone but additional clinicopathological parameters should also be considered. The extent of lymphadenectomy in surgical procedures should respect the presented topography of lymph node metastases.

Cited by 63 publications

References 33 publications

Redefining early gastric cancer

Redefining early gastric cancer

Clinical significance of lymphadenectomy in patients with gastric cancer

A Surgeon’s Role in the Management of Early Esophageal, EGJ and Gastric Lesions

Contact Info

Product

Resources

About