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06.11.2019 | Original Research

How Should We Measure the Quality of Lymphadenectomy for Gastric Cancer? Anatomical Versus Numerical Criterion

verfasst von: Stefano Rausei, Federica Galli, Georgios Lianos, Fausto Rosa, Andrea Cossu, Alberto Biondi, Francesco Martignoni, Ferdinando Carlo Maria Cananzi, Uberto Fumagalli, Sergio Alfieri, Roberto Persiani, Vittorio Quagliuolo, Domenico D’Ugo, Riccardo Rosati

Erschienen in: Journal of Gastrointestinal Cancer | Ausgabe 3/2020

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Abstract

Aim

To compare anatomical with numerical criterion to measure the quality of lymphadenectomy for gastric cancer.

Patients and Methods

We analyzed 447 gastric cancer patients with resectable tumor stage (R0 resection) with at least 16 examined lymph nodes.

Results

Of 447 patients, 82.6% underwent D2 lymphadenectomy for a median of total examined lymph nodes of 28. The 7-year disease-specific survival rate for the whole sample was 71.4%. Survival was significantly different between patients treated with D2 and D1 lymphadenectomy (77.4% versus 44.3%; p < 0.001) and between patients with total examined lymph nodes ≥ 28 and < 28 (74.5% versus 62.3%; p = 0.041). Anatomical criterion significantly differentiated 7-year survival in patients stratified according to a numerical parameter.

Conclusion

We should still consider the anatomical criterion as the best item to measure the quality of lymphadenectomy for gastric cancer.

Qiu MZ, Qiu HJ, Wang ZQ, Ren C, Wang DS, Zhang DS, et al. The tumor - log odds of positive lymph nodes-metastasis staging system, a promising new staging system for gastric cancer after D2 resection in China. PLoS One. 2012;7(2):e31736.CrossRef

Chen HN, Chen XZ, Zhang WH, et al. Necessity of harvesting at least 25 lymph nodes in patients with stage N2–N3 resectable gastric cancer. A 10-year, single-institution cohort study. Medicine. 2015;94(10):e620.CrossRef

Tanizawa Y, Terashima M. Lymph node dissection in the resection of gastric cancer: review of existing evidence. Gastric Cancer. 2010;13:137–48.CrossRef

Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, et al. Nodal dissection for patients with gastric cancer: a randomized controlled trial. Lancet Oncol. 2006;7:309–15.CrossRef

Wu CW, Hsiung CA, Lo SS. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg. 2004;91:283–7.CrossRef

Lu J, Wang W, Zheng CH, et al. Influence of total lymph node count on staging and survival after gastrectomy for gastric cancer: an analysis from a two-institution database in China. Ann Surg Oncol. 2017;24:486–93.CrossRef

Japanese Gastric Cancer Association Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017; 20(1):1-19.

Giuliani A, Miccini M, Basso L. Extent of lymphadenectomy and perioperative therapies: two open issues in gastric cancer. World J Gastroenterol. 2014;20(14):3889–904.CrossRef

Deng J, Zhang R, Pan Y, Wang B, Wu L, Hao X, et al. N stages of the seventh edition of TNM classification are the most intensive variables for predictions of the overall survival of gastric cancer patients who underwent limited lymphadenectomy. Tumor Biol. 2014;35(4):3269–81.CrossRef

10.

Karpeh MS, Leon L, Klimstra D, Brennan MF. Lymph node staging in gastric cancer: is location more important than number? An analysis of 1.038 patients. Ann Surg. 2000;232(3):362–71.CrossRef

11.

Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005;23:7114–24.CrossRef

12.

Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long term results of the MRC randomized surgical trial. Surgical co-operative Group. Br J Cancer. 1999;79:1522–30.CrossRef

13.

Rausei S, Dionigi G, Sano T, et al. Updates on surgical management of advanced gastric cancer: new evidence and trends. Insights from the first international course on upper gastrointestinal surgery--Varese (Italy), December 2, 2011. Ann Surg Oncol. 2013;20(12):3942–7.CrossRef

14.

Degiuli M, Sasako M, Ponti A, et al. Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study. J Clin Oncol. 1998;16:1490–3.CrossRef

15.

Barreto SG, Sirohi B. Why should we perform a D2 lymphadenectomy in gastric cancer? Future Oncol. 2017;13(23):2009–12.CrossRef

16.

Rausei S, Dionigi G, Boni L, Rovera F, Dionigi R. How does the 7th TNM edition fit in gastric cancer management? Ann Surg Oncol. 2011;18(5):1219–21.CrossRef

17.

Ahn HS, Lee HJ, Hahn S, Kim WH, Lee KU, Sano T, et al. Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 2010;116(24):5592–8.CrossRef

18.

Sobin LH, Wittekind CH, editors. TNM classification of malignant tumors. 6th ed. New York: Wiley; 2002.

19.

Greene FL, Page DL, Fleming ID, et al., editors. AJCC cancer staging manual: TNM classification of malignant tumors. 6th ed. New York: Springer-Verlag; 2002.

20.

In H, Solsky I, Palis B, et al. Validation of the 8th edition of the AJCC TNM staging system for gastric cancer using the national cancer database. Ann Surg Oncol. 2017;11:1–9.

21.

Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

22.

Gholami S, Janson L, Worhunsky DJ, et al. Number of lymph nodes removed and survival after gastric cancer resection: an analysis from the US gastric cancer collaborative. J Am Coll Surg. 2015;21:291–9.CrossRef

23.

Schwarz REI, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2006;14:317–8.CrossRef

24.

Bunt AM, Hermans J, Boon MC, van de Velde C, Sasako M, Fleuren GJ, et al. Evaluation of the extent of lymphadenectomy in a randomized trial of Western-versus Japanese-type surgery in gastric cancer. J Clin Oncol. 1994;12(2):417–22.CrossRef

25.

Chen T, Yan D, Zheng Z, et al. Evolution in the surgical management of gastric cancer: is extended lymph node dissection back in vogue in the USA? World J Surg Oncol. 2017;15:135.CrossRef

26.

Chon SH, Berlth F, Plum PS, et al. Gastric cancer treatment in the world: Germany. Transl Gastroenterol Hepatol. 2017;2:53.CrossRef

27.

Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol. 2002;9(8):775–84.CrossRef

28.

Nitti D, Marchet A, Olivieri M. Ratio between metastatic and examined lymph node is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitution experience. Ann Surg Oncol. 2003;2(5):S54–7.

29.

Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, et al. The ratio between metastatic and examined lymph nodes is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy. Ann Surg. 2007;245:543–52.CrossRef

30.

Xu D, Geng Q, Long Z, Zhan YQ, Li W, Zhou ZW, et al. Positive lymph node ratio is an independent prognostic factor in gastric cancer after D2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol. 2009;16:319–26.CrossRef

Titel: How Should We Measure the Quality of Lymphadenectomy for Gastric Cancer? Anatomical Versus Numerical Criterion
verfasst von: Stefano Rausei
Federica Galli
Georgios Lianos
Fausto Rosa
Andrea Cossu
Alberto Biondi
Francesco Martignoni
Ferdinando Carlo Maria Cananzi
Uberto Fumagalli
Sergio Alfieri
Roberto Persiani
Vittorio Quagliuolo
Domenico D’Ugo
Riccardo Rosati
Publikationsdatum: 06.11.2019
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Cancer / Ausgabe 3/2020
Print ISSN: 1941-6628
Elektronische ISSN: 1941-6636
DOI: https://doi.org/10.1007/s12029-019-00321-x

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How Should We Measure the Quality of Lymphadenectomy for Gastric Cancer? Anatomical Versus Numerical Criterion

Abstract