Immunohistochemical detection of lymph node microinvolvement in node-negative gastric cancer

Kikuchi, Masanori; Tsuchiya, Atsuo; Ando, Yohei; Yoshida, Takatoshi; Takenosita, Seiichi

doi:10.1007/s101200050042

Cited by 45 publications

(33 citation statements)

References 16 publications

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“…Even when a routine histologic examination shows no metastasis in the lymph nodes, studies by immunohistochemistry or molecular biology sometimes detect micrometastases in the regional lymph nodes [96, 97, 98, 99, 100]. The proportion of patients with histologically node-negative but immunohistochemically node-positive EGC was 19% in mucosal cancer [98]and 34% in submucosal cancer [99].…”

Section: Future Perspectivesmentioning

confidence: 99%

Modern Treatment of Early Gastric Cancer: Review of the Japanese Experience

Adachi

Shiraishi²,

Kitano³

2002

Dig Surg

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Background: Recently, detections of early gastric cancer (EGC) have been increasing, and the treatment strategies for gastric cancer have been changing. To demonstrate recent clinical experience of EGC in Japan and to assess modern strategies for the treatment of EGC, we investigated the English-language literature of the past 10 years through computer searches. Methods: This article intends to provide gastric surgeons with recent Japanese experience of the treatment for EGC. In a search for modern treatments of EGC, we selected 100 papers published in well-known medical journals, and focused on the following items of EGC: (1) prognostic factors, (2) endoscopic treatment, (3) surgical procedures, and (4) Japanese guidelines. Results: The most important factor influencing the survival of patients with EGC is the status of lymph node metastasis. The incidence of lymph node metastasis is 1–3% for mucosal cancers and 11–20% for submucosal cancers. Endoscopic mucosal resection (EMR) is a technique for the treatment of EGC, and the recent indication includes the tumors confined to the mucosa up to 3 cm in size or those invading the superficial submucosa. Surgical procedures include conventional Billroth I gastrectomy, limited resections, and laparoscopic surgery. Laparoscopic wedge resection using the lesion-lifting method and laparoscopy-assisted distal gastrectomy provide less pain, faster recovery and shorter hospital stay. Guidelines for the treatment of gastric cancer proposed by the Japanese Gastric Cancer Association show that patients with mucosal cancer can be managed by EMR or distal gastrectomy, whereas patients with submucosal cancer are candidates for distal gastrectomy with lymph node dissection. Conclusion: Although the prognosis of patients with EGC depends on the presence or absence of lymph node metastasis, most are successfully treated by modern endoscopic or surgical techniques. Laparoscopic surgery and limited resections will contribute to the better quality of life of patients with EGC.

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Section: Future Perspectivesmentioning

confidence: 99%

Modern Treatment of Early Gastric Cancer: Review of the Japanese Experience

Adachi

Shiraishi²,

Kitano³

2002

Dig Surg

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“…Wedge resekcija za karcinom želuca Istraživači iz japana favorizuju opsežnu disekciju limfatika (d2,d3) dok studije sa Zapada nisu utvrdile prednost limfadenektomije iznad d1. 95 Nekoliko studija, uključujući i meta-analize poredile su d1 i d2 resekciju limfatika i zaključile da d2 resekcija nije pokazala nikakav benefit u smislu dužine preživljavanja a bila je povezana sa većim morbiditetom. 17,96,97 Međutim, neke studije su pokazale da se nakon manje modifikacije d2 disekcije, javlja sličan broj komplikacija kao i kod d1 disekcije.…”

Section: Minimalno Invazivne Operativne Procedures Za Karcinom žElucaunclassified

“…95 Prema iskustvima japanaca, istraživači iz Evrope i sad istražuju na koji način bi sLNB tehnologija mogla da se koristi u populaciji njihovih bolesnika sa karcinomom želuca, koji dolaze sa značajno više zahvaćenih nodusa. Iako je sLNB postala deo izmenjene paradigme u tretmanu ranog karcinoma želuca u japanu, njegova primena u populaciji pacijenata sa uznapredovalom bolešću je manje jasna.…”

Section: Minimalno Invazivne Operativne Procedures Za Karcinom žElucaunclassified

'Sentinel node' place navigation surgery and minimally invasive surgical techniques in the treatment of gastric cancer

Mitrović¹

2012

Mat Med

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UvodNovi talas u hirurgiji karcinoma digestivnog sistema pokazuje težnju za individualizacijom hirurgije tj. stvaranju dovoljno sigurne zone u selekciji najprihvatljivijeg operativnog tretmana za svakog pacijenta. Principi hirurškog lečenja menjaju se od ekstenzivne ka rezonskoj, manje radikalnoj hirurgiji zasnovanoj na bezbednosti i postoperativnom kvalitetu života pacijenta(QOL). 1,2,3,4 Uprkos modernizaciji dijagnostike, napretku u prevenciji i savremenom hirurškom lečenju karcinom želu-ca je i dalje veliki problem čovečanstva zbog velike rasprostranjenosti i kasnog prepoznavanja. da bi se poboljšao kvalitet života, kod bolesnika od karcinoma želuca, primenjene su razne modifikacije hirurškog tretmana u skladu sa biologijom tumora, kao što su endoskopska mukozna i submukozna resekcija tumora, klasične i laparoskopske parcijalne gastrektomije sa ograničenom limfadenektomijom 5,6,7,8,9 Te minimalno invazivne tehnike su dobile značajnu pažnju zbog boljeg postoperativnog ishoda u poredjenju sa konvencionalnim radikalnim operacijama, kao što su gastrektomije sa ekstenzivnim limfadenektomijama. 10,11 Pretpostavke za usvajanje ograničene limfadenektomije za rani želudačni karcinom, su da je regionalna ili sistemska limfadenektomija prikladna za klinički sumnjive ili patološki dokazane metastaze u regionalnim limfnim žljezdama 12 dakle, kada ne postoji mogućnost metastaza u regionalnim limfnim čvorovima, operacije bez limfadenektomija ili sa ograničenom limfadenektomijom bi trebale biti dovoljne za odabrane pacijente 13 savremeni pristup ovoj problematici podrazumeva analizu jedne ili više regionalnih limnih čvorova koji prvi primaju metastaze. sa obzirom na varijetete limfotoka, ne može se govoriti o standardnim lokalizacijama tih žlezda, u odnosu na lokalizaciju tumora u zahvaćenom organu, te je osnovni cilj savremene hirurgije upravo pronalaženje, ekstirpacija i adekvatna patohistološka analiza tih žlezda koje su nazvane limfne žlezde čuvari.Koncept biopsije stražarećih limfnih nodusa je jedna od mogućnosti i dijagnostički alat kojim se mogu identifikovati prethodno nedetektovane metastaze u limfnim žlezdama i uticati na promenu terapijske strategije kod karcinoma želuca. 4 Iako ne postoji dovoljno dokaza o primeni ovog koncepta za karcinom želuca, istraživanja su pokazala da sLN navigacija tokom operacije može uputiti na alternativni hirurški tretman u odnosu na konvencionalne otvorene gastrektomije, pod uslovom da su ispunjene odgovarajuće indikacije. 30,31,32,33 sve ove činjenice nam ukazuju na to da biopsija stražarećih nodusa, uz adekvatnu histopatološku obradu može rezultirati još selektivnijem odredjivanju stepena radikalnosti operativnog zahvata kod karcinoma želuca. Istorijat i razvoj ideja i tehnikaLimfni nodus "stražar" (sentinel lymph node, sLN) je prvi limfni nodus ili nodusi koji prima aferentnu limfnu drenažu iz malignog tumora i koristi se za prikazivanje statusa ostalih limfnih nodusa u pripadajućem limfatičkom basenu. Verovatnoća da su limfne žlezde pripadajućeg basena pozitivne kada je stražare-...

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“…Even when a routine histologic examination shows no lymph node metastasis, studies by immunohistochemistry or molecular biology often detect micrometastases in the regional lymph nodes [38][39][40][41][42][43][44]. The proportion of patients with immunohistochemically node-positive gastric cancer was 19% in mucosal cancer [40], 34% in submucosal cancer [41], and 43% in histologically node-negative gastric cancer [42].…”

Section: Lymph Node Metastasismentioning

confidence: 99%

Surgery for gastric cancer: 10-year experience worldwide

2001

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extended lymph node dissection has been traditional in Japan, and critical studies from several Western countries suggest that there are improved surgical results after extended lymph node dissection. Therefore, it is important to evaluate the current information on the clinical and pathological characteristics of, and the surgical results for gastric cancer worldwide.To demonstrate recent experience of gastric cancer surgery throughout the world and to evaluate modern strategies for the treatment of gastric cancer, we investigated the English-language literature of the past 10 years, reviewed more than 100 studies concerning controversial issues in gastric cancer treatment, and assessed the current status of gastric cancer surgery worldwide. This review was generally based on promising papers published in well known medical journals, and focused on the following items: (1) surgical results worldwide, (2) lymph node metastasis, (3) lymph node dissection, (4) splenectomy, (5) prognostic factors, and (6) new therapeutic trends. Surgical results worldwideThe review of English-language publications from 1970 to 1990 showed that the operative mortality rate following surgery for gastric cancer had declined to a mean of 8% and a median of 5% [1]. In the British hospital, operative mortality decreased from 15% to 7%, and the 5-year survival rate increased from 5% to 11% [2]. In another British hospital, the proportion of patients with early gastric cancer rose from 1% to 15%, that of stage I disease rose from 4% to 26%, and that of potentially curative resection rose from 31% to 53% [3]. After curative resection, the 5-year survival rate was 60%, and the operative mortality and morbidity rates were 6% and 17%, respectively.In Sweden, the 5-year surival rate after gastrectomy for cancer increased from 19% to 25%, mainly owing to Abstract To demonstrate recent experience of gastric cancer surgery worldwide and to evaluate modern strategies for the treatment of gastric cancer, we investigated the English-language literature of the past 10 years, based on papers published in well-known medical journals. In many countries, the increased detection of early gastric cancer, advanced operative procedures, and careful postoperative management have improved the surgical results of gastric cancer over the years. Although randomized controlled trials in Europe showed no survival benefit of D2 resection over D1 resection, the results must be interpreted with caution and cannot be extrapolated to Japanese patients, because the morbidity and mortality after D2 gastrectomy in Japan are much less than those after D1 gastrectomy in Europe. Recently, less invasive treatments, including endoscopic mucosal resection and laparoscopic gastrectomy, have become feasible for patients with early gastric cancer, but their risks and benefits compared with traditional gastrectomy are unclear.

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Immunohistochemical detection of lymph node microinvolvement in node-negative gastric cancer

Cited by 45 publications

References 16 publications

Modern Treatment of Early Gastric Cancer: Review of the Japanese Experience

Modern Treatment of Early Gastric Cancer: Review of the Japanese Experience

'Sentinel node' place navigation surgery and minimally invasive surgical techniques in the treatment of gastric cancer

Surgery for gastric cancer: 10-year experience worldwide

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