Recurrence of a pT2N0cM0 Lower Third Gastric Cancer with No. 6 Lymph Node Micrometastasis after R0 Extended Surgery. Should Adjuvant Therapy be Performed in Conventionally Node-Negative but Micrometastasis-Positive pT2 Gastric Cancer?

Excerpt

D2 lymphadenectomy has been established as the standard procedure for the prevention of lymph node recurrence in resectable stage IB–III gastric cancer. Nevertheless, R0 resection after optimal D2 dissection did not always prevent disease recurrence; one of the key causative factors is lymph node micrometastasis [1]. The seventh TNM classification of malignant tumors clearly stated that micrometastases in regional and distant lymph nodes detected by morphological techniques (serial sectioning combined with H-E staining and immunohistochemistry) should be reported and calculated in the staging of the disease (pN1mi and pM1 LYM+). However, no definitive criteria for examination of lymph nodes micrometastasis were provided [2]. Furthermore, the seventh edition of TNM classification for gastric cancer and the third Japanese classification of gastric carcinoma did not incorporate lymph node micrometastasis in pN categorization and staging [3, 4]. …