Current standards of lymphadenectomy in gastric cancer

Lezama, Manuela Monrabal; Duncan, Newton O.; Bertona, Sofía; Schlottmann, Francisco

doi:10.1007/s13304-023-01576-7

Cited by 4 publications

(2 citation statements)

References 45 publications

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“…Lymph nodes are the primary sites of antigen presentation, T cell activation, and immune memory generation, and they are therefore crucial to the anti-tumor immune response [ 94 , 95 , 96 ]. However, it is necessary to remove the lymph nodes proximal to the tumors during surgical resection in order to clear any residual metastatic cells [ 97 , 98 , 99 , 100 ]. On the other hand, destroying the integrity of the lymphatic system may also lead to the accumulation of lymph fluid and complications such as lymphatic embolism, which further the immune function [ 101 ].…”

Section: Effect Of Pelvic Lymph Node Dissection On Immunotherapy For ...mentioning

confidence: 99%

Bladder Cancer: Immunotherapy and Pelvic Lymph Node Dissection

Fan,

Deng,

Wang

et al. 2024

Vaccines

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Bladder cancer, a common malignancy of the urinary system, is routinely treated with radiation, chemotherapy, and surgical excision. However, these strategies have inherent limitations and may also result in various side effects. Immunotherapy has garnered considerable attention in recent years as a novel therapeutic approach. It harnesses and activates the patient’s immune system to recognize and eliminate cancer cells, which not only prolongs therapeutic efficacy but also minimizes the toxic side effects. Several immune checkpoint inhibitors and cancer vaccines have been developed for the treatment of bladder cancer. Whereas blocking immune checkpoints on the surface of tumor cells augments the effect of immune cells, immunization with tumor-specific antigens can elicit the production of anti-tumor immune effector cells. However, there are several challenges in applying immunotherapy against bladder cancer. For instance, the efficacy of immunotherapy varies considerably across individual patients, and only a small percentage of cancer patients are responsive. Therefore, it is crucial to identify biomarkers that can predict the efficacy of immunotherapy. Pelvic lymph nodes are routinely dissected from bladder cancer patients during surgical intervention in order to remove any metastatic tumor cells. However, some studies indicate that pelvic lymph node dissection may reduce the efficacy of immunotherapy by damaging the immune cells. Therefore, the decision to undertake pelvic lymph node removal should be incumbent on the clinical characteristics of individual patients. Thus, although immunotherapy has the advantages of lower toxic side effects and long-lasting efficacy, its application in bladder cancer still faces challenges, such as the lack of predictive biomarkers and the effects of pelvic lymph node dissection. Further research is needed to explore these issues in order to improve the efficacy of immunotherapy for bladder cancer.

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Section: Effect Of Pelvic Lymph Node Dissection On Immunotherapy For ...mentioning

confidence: 99%

Bladder Cancer: Immunotherapy and Pelvic Lymph Node Dissection

Fan,

Deng,

Wang

et al. 2024

Vaccines

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“…D2 lymphadenectomy (D2) is generally accepted as the standard procedure during curative gastrectomy [2,3]. In contrast with Eastern countries, where D2 has been performed with satisfying outcomes for decades, D1 lymphadenectomy (D1) is more commonly performed in the West [7]. The theoretical benefit of D2 is based on an increased number of resected nodes which implies more accurate staging, the removal of potential metastatic lymph nodes, and a reduction in the risk of loco-regional recurrence [8,9].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Impact of D2 Lymphadenectomy during Gastrectomy for Cancer: Individual Patient Data Meta-Analysis and Restricted Mean Survival Time Estimation

Aiolfi,

Bona,

Bonitta

et al. 2024

Cancers

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Background: Debate exists concerning the impact of D2 vs. D1 lymphadenectomy on long-term oncological outcomes after gastrectomy for cancer. Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched and randomized controlled trials (RCTs) analyzing the effect of D2 vs. D1 on survival were included. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were assessed. Restricted mean survival time difference (RMSTD) and 95% confidence intervals (CI) were used as effect size measures. Results: Five RCTs (1653 patients) were included. Overall, 805 (48.7%) underwent D2 lymphadenectomy. The RMSTD OS analysis shows that at 60-month follow-up, D2 patients lived 1.8 months (95% CI −4.2, 0.7; p = 0.14) longer on average compared to D1 patients. Similarly, 60-month CSS (1.2 months, 95% CI −3.9, 5.7; p = 0.72) and DFS (0.8 months, 95% CI −1.7, 3.4; p = 0.53) tended to be improved for D2 vs. D1 lymphadenectomy. Conclusions: Compared to D1, D2 lymphadenectomy is associated with a clinical trend toward improved OS, CSS, and DFS at 60-month follow-up.

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Outcomes after gastrectomy according to the Gastrectomy Complications Consensus Group (GCCG) in the Dutch Upper GI Cancer Audit (DUCA)

Visser,

Voeten,

Gisbertz

et al. 2024

Gastric Cancer

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Background In 2019, the Gastrectomy Complications Consensus Group (GCCG) published a standardized set of complications aiming toward uniform reporting of post-gastrectomy complications. This study aimed to report outcomes after gastrectomy in the Netherlands according to GCCG definitions and compare them to previously reported national results and the European database reported by the GCCG. Methods This nationwide, population-based cohort study included all patients undergoing gastrectomy for gastric cancer registered in the DUCA in 2020–2021. Postoperative morbidity and 30-day/in-hospital mortality were analyzed according to the GCCG definitions. For all patients, baseline characteristics and outcomes were compared with the GCCG cohort consisting of 27 European expert centers (GASTRODATA; 2017–2018). Results In 2020–2021, 782 patients underwent gastrectomy in the Netherlands. Variation was seen in baseline characteristics between the Dutch and the GCCG cohort (N = 1349), most notably in minimally invasive surgery (80.6% vs 19.6%, p < 0.001). In the Netherlands, 223 (28.5%) patients developed a total of 407 complications, the most frequent being non-surgical infections (28.5%) and anastomotic leakage (13.4%). The overall complication and 30-day mortality rates were similar between the Dutch and GCCG cohort (28.5% vs 29.8%, p = 0.563; 3.7% vs 3.6%, p = 0.953). Higher surgical and endoscopic/radiologic reintervention rates were observed in the Netherlands compared to the GCCG cohort (10.7% vs 7.8%, p = 0.025; 10.9% vs 2.9%, p < 0.001). Conclusion Reporting outcomes according to the standardized GCCG definitions allows for international benchmarking. Postoperative outcomes were comparable between Dutch and GCCG cohorts, but both exceed the international benchmark for expert gastrectomy care, highlighting targets for national and international quality improvement.

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Current standards of lymphadenectomy in gastric cancer

Cited by 4 publications

References 45 publications

Bladder Cancer: Immunotherapy and Pelvic Lymph Node Dissection

Bladder Cancer: Immunotherapy and Pelvic Lymph Node Dissection

Long-Term Impact of D2 Lymphadenectomy during Gastrectomy for Cancer: Individual Patient Data Meta-Analysis and Restricted Mean Survival Time Estimation

Outcomes after gastrectomy according to the Gastrectomy Complications Consensus Group (GCCG) in the Dutch Upper GI Cancer Audit (DUCA)

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