[Survival after gastrectomy for cancer. 209 cases].
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Objective To study the relationship between the number of examined lymph nodes and the prognosis of colorectal cancer by TNM stage. Methods According to the number of examined lymph nodes, 567 patients of colorectal carcinoma who underwent resection were divided into three groups: ≤ 6,7-11 and ≥ 12, the 5-year overall survival rates of three groups were compared. For each TNM stage ( stage Ⅰ -Ⅳ ) , patients were substratified into two groups basing on the number of examined lymph nodes: 0. 05 ) , however, the 5-year survival rates of stage Ⅱ and Ⅲ colorectal cancer in ≥12 group were significantly higher than<12 group(71. 1% vs. 32. 6% ,48. 8% vs. 30. 0% ,P<0. 05) , multivariable analysis revealed that the number of lymph nodes examined was an independent factor of prognosis of stage Ⅱ and Ⅲ colorectal cancer. Conclusions The number of examined lymph nodes significantly influenced the 5-year overall survival rate of TNM stage Ⅱ and Ⅲ colorectal cancer.
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Colorectal neoplasm; Neoplasm staging; Prognosis; Lymph node
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To establish the indications for proximal resection with dissection of perigastric lymph nodes in order to treat adenocarcinoma of the gastric cardia.We analyzed the clinicopathological features of 110 resected adenocarcinomas of the gastric cardia with respect to the appropriate operative method and extent of lymphadenectomy for treatment.Of the 110 patients, 93 underwent curative resection. The D2 group (total gastrectomy with dissection of extended regional lymph nodes) revealed higher morbidity and mortality rates compared to the D1 group (proximal resection with dissection of perigastric lymph nodes). The risk of lymph node metastasis was determined by depth of invasion, size of tumors, and gross findings of tumors.The appropriate operative method for adenocarcinoma of the gastric cardia requires: (i) tumor size less than 4 cm; and (ii) gross findings indicating a superficial type of lesion, which are recommended for proximal resection with dissection of perigastric lymph nodes.
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To evaluate the clinical significance of early gastric cancer by means of an analysis of the results of surgical treatment of gastric cancer in stage T1/T2.A retrospective review and survival analysis of 132 patients with stage T1/T2 stomach cancer treated from 1983 through 1993 was performed.The average tumor size, lymph node involvement, postoperative recurrence and survival rate were significantly different between gastric cancer in stage T1 and T2. It was true of both groups of patients that the survival rate of patients with and without lymph node involvement was significantly different. However, the survival rate of patients in stage T2 but without lymph node involvement was not significantly different as compared to that of patients in stage T1.For stage T1 stomach cancer, because of possible lymph node involvemnt, local mucosal excision of tumor is not recommended. For stage T2 stomach cancer without lymph node metastasis, it can be regarded as cancer still in its early stage when postoperative adjunct therapy is to be given.
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A 6 3-year-old male presented with dysphagia. Gastrointestinal endoscopic examination showed advanced gastric cancer type 3, which was diagnosed as well-differentiated adenocarcinoma. Computed tomography(CT)showed bilateral lung tumors, hugely enlarged Virchow and para-aortic lymph nodes. He was treated with combination chemotherapy of weekly paclitaxel(PTX)and doxifluridine(5'-DFUR). PTX was administered at a dose of 80mg/m2 on day 1, 8 and 15, and 5'- DFUR was orally administered at a dose of 533mg/m / 2day for 5 days followed by withdrawal for 2 days. After four courses of treatment, CT showed an almost complete disappearance of the lung and lymph node metastases. After 13 courses of treatment, total gastrectomy and lymph node dissection were performed. One year postoperatively, the patient died of a recur- rence.
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To find out the extent of involvement of the para-aortic nodes in patients with adenocarcinoma of the gastric cardia. Open prospective study. Teaching hospital, Italy. 23 patients with advanced adenocarcinoma of the cardia (type II, n = 10, and type III, n = 13) who were treated by total gastrectomy with resection of the distal oesophagus and extended lymphadenectomy (D4) between January 1997 and June 1999. These were compared with 21 patients with advanced carcinoma of the proximal third of the stomach who had total gastrectomy with D4 lymphadenectomy during the same period. Lymph nodes were retrieved immediately postoperatively and assigned to the appropriate station according to the classification of the Japanese Research Society for Gastric Cancer. Number of para-aortic and other nodes involved. 22 of the 23 patients had lymph node metastases, and in 5 the para-aortic nodes were involved (N4). N3 lymph nodes were involved in only 1 patient, despite involvement of para-aortic nodes. Among the 5 patients with N4 metastases, 1 had only N1 metastases in addition, with no involvement of N2 or N3 nodes. Patients with involved N4 nodes had more nodes involved overall than those who did not (mean (SD) 17 (5) compared with 8 (12)). 5/23 patients with advanced carcinoma of the cardia had involved para-aortic nodes. This may have some prognostic value, but larger studies of D4 lymphadenectomy specimens is required.
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This study presents the results achieved in 2,000 patients who underwent gastric resection and who had been selected from amongst 3,074 cases of gastric neoplasia included in the Retrospective Study of Carcinoma of the Stomach, carried out by the "Italian Stomach Cancer Group" of the Association of Italian Hospital Surgeons (ACOI). In terms of the UICC TNM classification, these patients consisted of 234 stage I patients, 494 stage II patients 1,011 stage III patients and 261 stage IV patients. The overall operative mortality was 7.1 percent. This was lower after subtotal distal resection. The long-term survival tended to fall in proportion with the stage of the illness, whereas the degree of the exeresis did not appear to have any impact. The overall survival at 5 years in the patients who survived the operation was 45%, that following distal resection was 54% and that after total gastrectomy was 33%. The survival rate in terms of the stage ranged from 86% for Early Gastric Cancers to 28% for the patients who underwent surgery at stage III i.e. when they had metastatic lymph nodes.
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Results of surgical treatment of 156 patients were analyzed. There were no metastases to the lymph nodes in patients with invasion of mucous membrane only. In patients with invasion of the tumor into a submucous layer regional metastases were revealed in 18 (19%) cases. Number of affected lymph nodes varied from 1 to 7 (2.7, on the average). Metastases to 1 lymph node were revealed in 9 (50%) patients, to 2-3 nodes -- in 5 patients, to 5-7 nodes -- in 4 patients. In 14.78% patients metastases were only to perigastric lymph nodes, in 4 cases -- to nodes of the second level (N2). Invasion of the tumor into submucous layer, location and size of the tumor were the main factor of risk of lymphatic cancer spread. Frequency of lymphatic cancer spread does not exceed 10% in any variant. In patients with proximal tumor, infiltrative growth and size more than 4 cm, tumor lymphatic metastases are diagnosed in each third person. It is concluded that gastrectomy or distal subtotal resection of the stomach with modified D2 lymphatic dissection is the method of choice in treatment of patients with invasion of stomach cancer into submucous layer.
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Purpose: Lymph node metastasis is a stage-determining factor and the most important prognostic factor for colon cancer patients. We aimed to verify the influence of the aspects of lymph node metastatic level on the prognosis of the stage III colon cancer patients. Methods: We studied the survival rate of ninety-eight patients with stage III colon cancer who underwent an open and laparoscopic surgery at Eulji University Hospital from November 1998 to December 2009. We evaluated the survival rate and prognostic factors including the level of positive lymph node and additional factors. The level of positive lymph node was classified as either level I (pericolic and intermediate lymph node metastasis) or level II (apical lymph node metastasis). Results: The average age of the patients was 62.7 years (range, 30 to 89 years) old and the mean follow-up period was 45.9 months (range, 2 to 129 months). The comparison of the survival rates based on the level of lymph nodes shows that level I was 89.5% while level II was 41.7% (P=0.002). Multivariate analysis showed that level of positive lymph node was a significant prognostic factor. Conclusion: In this study, the level of lymph node metastasis in stage III colon cancer was significant prognostic factor. Therefore, exact evaluation and further treatment plans should be determined based on clear analysis of various aspects of the lymph nodes acquired by accurate and meticulous surgery. Keywords: Colon cancer, Lymph node, Survival rate, Prognosis
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In 65 patients who underwent surgical resection of the gastric cancer invading to proper muscle layer (pm cancer), lymph node involvement at the time of resection and the site of recurrence were investigated. Patients who underwent gastrectomy for submucosal (sm cancer) or subserosal (ss alpha.beta cancer) gastric cancers during the same period served as controls. Lymph node involvement was positive at a higher rate in the pm cancer than in the sm cancer, but the rate for number of lymph node metastases was not dependent on the stage of lesions. Of the lesions in the pm cancer, those of the Borrmann type involved lymph nodes at a particularly high rate. Of the metastatic pattern in the lymph nodes, the rate of severe metastases in pm cancer was higher than in the sm cancer. In the pm cancer, the cancer recurred in the liver and peritoneum, but not in any lymph nodes, thus suggesting that the surgical resection and the dissection of regional lymph nodes had been successful.
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