Risk factors for atypical lymph node metastasis in gastric cancer

Abstract

The present study aimed to evaluate atypical lymph node metastasis rates according to tumor depth, size, and location in patients with gastric cancer. Methods: A total of 727 gastric adenocarcinoma patients, with metastasis to 1 or 2 lymph nodes, who underwent radical gastrectomy with curative intent from May 2003 to May 2017, were enrolled in this study. The characteristics of atypical (skip or transversal) metastases were evaluated according to the following risk factors: longitudinal versus circumferential location, size, and T stage of the tumor. Results: The rates of skip and transversal metastases were 8.4% and 15.5%, respectively. Skip metastases were present throughout, regardless of the primary tumor location. On the contrary, transversal metastases of gastric cancer were most frequently observed in the lower third region (19.5%, P=0.002). When the size of the tumor is large (>4 cm), transversal metastasis was found to be significantly more common (P=0.035), compared with skip metastasis, which was less common (P=0.011). There was no significant correlation between atypical metastases and tumor depth. Conclusion: Lower and larger tumors were more likely to have transversal metastases compared with others; however, skip metastases were less common in large tumors.

Surgeon–Pathologist Team Approach Dramatically Affects Lymph Nodes Detection and Improves Patients’ Short-Term Outcome

“…The control group included 25 males and 25 females, the mean age at diagnosis was 74 years old (range: 37−92 years); 4 patients underwent urgency surgery for occlusive or bleeding disease; 5 patients were subjected to neoadjuvant chemotherapy according to the FLOT regimen. The majority of tumors ( n = 30, 60%) were located in antral region, and were represented by low-grade ( n = 19, 61%) [ 15 ], tubular moderately differentiated adenocarcinoma ( n = 14, 28%) [ 21 ], intestinal type ( n = 18, 36%) according to Lauren [ 23 ], tubular 2 (tub2) ( n = 14, 28%) following JGCA classification [ 24 ]. Six patients suffered from early gastric cancer.…”

“…11p) [ 14 ]. Many theories have been proposed to explain such an occurrence, most of them dealing with the complex, multidirectional nature of the lymphatic drain of the stomach [ 3 , 13 , 15 ]. It has been demonstrated that patients showing skip metastasis or multiple metastatic stations, especially in the CnLN compartment, experience shorter survival [ 16 ].…”