[Relationship between the dissected lymph node number and the prognosis in D(2) gastrectomy for gastric cancer].
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To examine the relationship between the dissected lymph-node number and the prognosis in D(2) gastrectomy for gastric cancer.From January 1996 to January 2005, 457 patients with primary gastric cancer undergone gastrectomy with different extent of lymphadenectomy in our hospital were followed-up in term of prognostic benefit.In lymph-node metastasis group, the 1-, 3-, 5-year survival rates were 82.4%, 49.0%, 33.4% with dissection of >20 nodes and 71.5%, 49.7%, 40.1% with dissection of 16-20 nodes. In the group without lymph-node metastasis, the 1-, 3-, 5-year survival rates were 98.2%, 92.7%, 84.7% with dissection of >20 nodes and 94.0%, 89.7%, 81.4% with dissection of 16-20 nodes. Whether or not it had lymph-node metastasis, the survival curve failed to show any significant difference with regard to the extent of lymph node dissection.As to lymphadenectomy for gastric cancer, it is enough to excise the lymph node between 16 and 20. The number of excised lymph node should not be overemphasized unless it is metastasized.Keywords:
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Abstract Background The 5-year survival rate in patients with gastric cancer is still poor, and lymph node metastasis is considered one of the most important prognostic factors. However, there are controversies in the classification of lymph node metastasis in gastric cancer. This study was carried out to investigate whether the metastatic lymph node ratio is a reliable classification of lymph node metastasis in gastric cancer in Chinese. Methods 224 cases with gastric cancer with more than D1 dissection were retrospectively reviewed. The association between the total number of resected lymph nodes and the number of metastatic lymph nodes was determined. The prognostic value of the metastastic node ratio, defined as the ratio of the number of metastatic lymph nodes over the total number of resected lymph nodes, and the pN classification was assessed. Results The number of metastatic lymph node increased with the number of total resected lymph nodes. A Cox regression revealed that the metastatic node ratio, the number of metastatic nodes, histological type, and histological growth pattern independently influenced prognosis. The 5-year survival rates were 78%, 61%, 25%, 0% in cases with a metastastic node ratio of 0%, > 0% but < 40%, 40–80%, > 80%, respectively ( P < 0.001), and were 78%, 62%, 38%, 0% in cases with gastric cancer histologically classified as pN0, pN1, pN2, pN3, respectively ( P < 0.001). Conclusion The metastatic lymph node ratio is a simple and useful independent prognostic factor. It may obviate possible confounding factors that are related to stage migration, and should be considered as an important component in the lymph node category.
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Complete tumor removal with margins of clearance at the resection lines must be the aim of today's surgical treatment of gastric cancer, and this must be applied even in lymph node dissection. But, over the last few decades, the extent and impact of lymphadenectomy remains controversial. Whereas Japanese centers advocate extensive lymph node dissection as the base of their excellent results, many Western surgeons, supported by actual randomized trials, believe that the potential benefit of such procedures cannot outweigh the risk of increased postoperative morbidity and mortality. However, if lymphadenectomy is restricted to the removal of nodes only, it does not influence the operative risk. Further, the lymph node ratio and number of lymph nodes involved are relevant prognostic parameters. Survival improvement can be achieved in a moderate degree of metastatic involvement of the nodes (pN0,1). Therefore, systematic lymph node dissection should be an integral part of the curative resection sought. Limited or no lymphadenectomy might be indicated in noncurative surgery or in special types of mucosal early gastric cancer, respectively. Semin. Surg. Oncol. 17:117–124, 1999. © 1999 Wiley-Liss, Inc.
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To better understand the role of the number of lymph nodes retrieved on long-term outcome of gastric cancer treatment, 154 patients who had undergone curative resection, with dissection of >15 nodes were retrospectively studied. Dissection of perigastric and extraperigastric lymph nodes, defined as 'extended' (>26 nodes dissected) in 39 cases and 'limited' (< or = 26 nodes dissected) in 115 cases, was performed. A total of 3479 lymph nodes (mean 22.6 per specimen), were dissected and of these 721 showed metastases. A mean of 8.1 lymph node metastases, per metastatic case, was found. Regression analysis showed no independent factor associated with the extent of lymphadenectomy. Depth of wall invasion (p=0.000) and histological growth pattern (p=0.044) were independently associated with the number of lymph nodes involved (pN0, pN1 1-7, pN2 >7). The cumulative 5-year survival rate was 47% in patients without lymph node metastases; 29% in those with 1-7 nodes involved and 17% in those with >8 nodes involved (p=0.002). Receiver operating characteristic (ROC) curve analysis, in 65 nodenegative cancer cases, demonstrated an area under the curve for vital status (alive or dead) of 0.602 (95% CI: 0.473 - 0.721). All node-negative cases with a number equivalent to or exceeding the cutoff point of 23 nodes were alive. ROC analysis showed 11 to be the cutoff number of metastasized lymph nodes in correlation with vital status. Almost all those patients in whom the number of positive nodes was equivalent to, or exceeded the cutoff point had died (area under the ROC curve 0.633; 95% CI: 0.524 - 0.733). ROC analysis showed that the cutoff lymph node ratio, in relation to vital status, was 0.33. The majority of patients at or above this cutoff point had died (area under ROC curve 0.682; 95% CI: 0.574 - 0.776). Multivariate survival analysis showed that lymph node ratio was the only independent prognostic factor (p=0.001). The present findings suggest that, in lymphadenectomy with at least 15 nodes, the number and status of regional nodes dissected, irrespective of the location, provide reliable prognostic information on curatively resected gastric carcinomas.
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Objective: To identify the clinicopathological factors affecting the number of lymph nodes yielded from specimens obtained by laparoscopic-assissted resection of rectal cancer, and discuss further the possible causes of insufficient lymph nodes retrieval (<12). Methods: The clinicopathological data of 422 consecutive rectal cancer cases, who underwent radical laparoscopic rectal resection (R0) at our department during January to October 2015, were analyzed retrospectively. The correlation between the clinicopathological factors and the number of lymph nodes yielded from the surgical specimens was assessed statistically. Results: Age of the patient, length of specimen, tumor size and operating surgeon were significantly associated with the lymph node yield (all P<0.05). The total number of lymph nodes yielded in 351 patients without neoadjuvant therapy ranged 8-49, with an average of 22.5, and the lymph node metastasis rate was 0-100% with an average of 7.6%.The total number of lymph nodes yielded from the 71 patients receiving neoadjuvant therapy ranged 9-70, with an average of 18.3, and the lymph node metastasis rate was 0-73.0%, with an average of 7.6%. Neoadjuvant therapy decreased the total lymph node yield obviously (P<0.001), but didn't decrease the lymph node metastasis rate (P=0.636). Of all the patients investigated, 19 cases had less than 12 dissected lymph nodes, and 403 cases had at least 12 lymph nodes removed. Gender, tumor size and neoadjvant therapy were independent risk factors for yield of twelve or more lymph nodes (all P<0.05). Conclusions: Age of the patient, length of specimen, tumor size, operating surgeons and neoadjuvant therapy are significantly correlated with the total number of lymph nodes yielded from laparoscopically resected specimens of rectal cancer. Neoadjvant therapy may obviously decrease the number of yielded lymph nodes, while not decreases the lymph node metastasis rate. Male gender, small size of the tumor, and neoadjvant therapy are possible risk factors for harvesting less than 12 lymph nodes.
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Abstract Purpose The aim of this study is to examine the pattern of lymph node metastasis (lateral vs. mesenteric lymph nodes) in low rectal cancer. Methods This retrospective analysis included all patients undergoing laparoscopic total mesorectal excision plus lateral lymph node dissection for advanced low rectal cancer (up to 8 cm from the anal verge) during a period from July 1, 2017, to August 31, 2019, at the Department of Colorectal Surgery, Tianjin Union Medical Center. The decision to conduct lateral lymph node dissection was based on positive findings in preoperative imaging assessments. Results A total of 42 patients were included in data analysis. Surgery was successfully completed as planned, without conversion to open surgery in any case. A minimum of 10 mesenteric lymph nodes and 1 lateral lymph node on each side were dissected in all patients. Pathologic examination of resected specimens showed no metastasis to either mesenteric or lateral lymph nodes in 7 (16.7%) case, metastasis to both mesenteric and lateral lymph nodes in 26 (61.9%) cases, metastasis to mesenteric but not lateral lymph nodes in 4 (9.5%) cases, and metastasis to lateral but not mesenteric lymph nodes in 5 (11.9%) cases ( n = 2 in the obturator region; n = 3 in the iliac artery region). Conclusion A clinically significant proportion of low rectal cancer patients have metastasis to lateral lymph nodes without involvement of mesenteric lymph nodes. More carefully planned prospective studies are needed to verify this preliminary finding.
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To investigate the characteristics and patterns of lymph node metastasis in lung cancer, and to provide evidence for determining range of lymph node dissection.One hundred and five patients with lung cancer received complete resection combined with systematic lymph node dissection according to the mapping system developed by Naruke.A total of 801 lymph nodes were dissected from 105 lung cancer patients. The positive ratios of N1 and N2 were 15.9% and 14.9%, respectively. Twelve patients were found with skipping N2. These skipping N2 were located in 2, 4, 5, 6, 7 groups respectively. There was no significant relationship between size of primary tumor and lymph node metastasis. Small cell lung cancer showed the highest risk of lymph node metastasis. The metastatic rate of lymph node in adenocarcinoma was markedly higher than that in squamous cell carcinoma. Skipping mediastinal lymphatic metastasis was found more frequently in lower lobar tumors than that in upper lobar ones.Lymph node metastasis of lung cancer may occur in multiple groups and multiple regions, even in a skipping pattern. Systematic lymph node dissection should be routinely performed in pulmonary resection for lung cancer.
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Although changing a lymph node staging system from an anatomically based system to a numerically based system in gastric cancer offers better prognostic performance, several problems can arise: it does not offer information on the anatomical extent of disease and cannot represent the extent of lymph node dissection. The purpose of this study was to discover an alternative lymph node staging system for gastric cancer. Data from 6025 patients who underwent gastrectomy for primary gastric cancer between January 2000 and December 2010 were reviewed. The lymph node groups were reclassified into lesser-curvature, greater-curvature, and extra-perigastric groups. Presence of any metastatic lymph node in one group was considered positive. Lymph node groups were further stratified into four (new N0-new N3) according to the number of positive lymph node groups. Survival outcomes with this new N staging were compared with those of the current TNM system. For validation, two centers in Japan (large center, n = 3443; medium center, n = 560) were invited. Even among the same pN stages, the more advanced new N stage showed worse prognosis, indicating that the anatomical extent of metastatic lymph nodes is important. The prognostic performance of the new staging system was as good as that of the current TNM system for overall advanced gastric cancer as well as lymph node-positive gastric cancer (Harrell C-index was 0.799, 0.726, and 0.703 in current TNM and 0.799, 0.727, and 0.703 in new TNM stage). Validation sets supported these outcomes. The new N staging system demonstrated prognostic performance equal to that of the current TNM system and could thus be used as an alternative.
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Abstract Background and Objectives This study was aimed at evaluating the prognostic significance of the number of metastatic nodes in early gastric cancer (EGC). Methods In this multicenter retrospective study 652 cases of resected EGC were analyzed. We searched for lymph node metastases‐associated risk factors and to identify subsets of patients with different prognosis according to the number of involved nodes. Results Nodal involvement was observed in 14.1%. A significant correlation was found between the presence of node metastases and tumor size (RR 1.34, P = 0.001), submucosal invasion (RR: 3.14, P = 0.007), Lauren diffuse/mixed type (RR: 4.88, P < 0.001) and Kodama Pen A type (RR: 4.59, P < 0.001). The 10‐year survival rate was 92% for N0 cases, 82% and 73% for tumors with one to three and four to six positive nodes while it dropped to 27% with more than six metastatic nodes. Interestingly enough, the 10‐year risk of recurrence diminished with the increasing number of retrieved nodes (>15) even in N0 patients. Conclusions Nodal involvement confirmed to be a significant prognostic factor. In view of the trend to a lower risk of recurrence when more than 15 nodes were retrieved and the better staging achieved we consider D2 lymphadenectomy the treatment of choice. J. Surg. Oncol. 2006;94:275–280. © 2006 Wiley‐Liss, Inc.
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