Is Extensive Lymphadenectomy Necessary for Surgical Treatment of Intramucosal Carcinoma of the Stomach?

Iriyama, Keiji; Asakawa, Toyomatsu; Koike, Hiroshi; Nishiwaki, Hiroshi; Sano, Hiroshi

doi:10.1001/archsurg.1989.01410030059010

Cited by 85 publications

(55 citation statements)

References 6 publications

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“…It is well established that, as the depth of gastric carcinoma invasion into the gastric wall increases, the frequency and the degree of nodal metastasis also increases. Lymph nodal metastasis is present in 1.8-4.8% of EGC patients with mucosal invasion, but in 16.7-23.8% of those with submucosal invasion (Habu et al, 1986;Korenaga et al, 1986;Ohta et al, 1987;Iriyama et al, 1989;Sowa et al, 1989;Inoue et al, 1991;Moreaux and Bougaran, 1993). Thus, the local invasiveness of EGC may be correlated with the survival rate (Lawrence and Shiu, 1991).…”

Section: Survivalmentioning

confidence: 99%

“…It is not rare for a tumour that has been grossly diagnosed as mucosal carcinoma to infiltrate into the submucosal layer or deeper. We know for certain that the protruded type EGC less than 2.0 cm in diameter is limited to the mucosa and that it lacks nodal metastasis (Kitaoka et al, 1984;Korenaga et al, 1986;Ohta et al, 1987;Iriyama et al, 1989). In addition, if a tumour shows a depressed differentiated adenocarcinoma less than 1.0cm in diameter, then it has little chance of nodal metastasis (Takekoshi et al, 1994).…”

Section: Survivalmentioning

confidence: 99%

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Rationale for extensive lymphadenectomy in early gastric carcinoma

Miwa

Miyazaki²,

Sahara³

et al. 1995

Br J Cancer

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Summary The incidence of nodal metastasis in early gastric carcinoma (EGC) is 10-20%. However, the optimal nodal dissection for early gastric carcinoma has not been established. A retrospective study was conducted in 392 consecutive patients who underwent potentially curative distal gastrectomy for EGC between 1962 and 1990. Of these 295 patients treated after September 1972 were prospectively entered into an extensive lymphadenectomy protocol. These patients were compared with 97 patients with simple gastrectomy in respect of the causes of death after surgery and the 10 year disease-specific survival rate. The incidence of nodal metastasis in early gastric carcinoma patients was 13.0%. Operative mortality from extensive lymphadenectomy was almost the same as from simple gastrectomy (2.0% and 2.1% respectively). Extensive al., 1987; Ohta et al., 1987; Marczel et al., 1988;Lehnert et al., 1989;Percivale et al., 1989;Farley et al., 1992;Maehara et al., 1993). Nevertheless, the optimal extent of lymph node dissection for EGC has not been well established. Japanese surgeons normally perform extensive lymphadenectomy for EGC because a certain proportion of these patients have lymph nodal involvement and carcinoma recurrence is not rare. In contrast, most surgeons in Western countries do not use aggressive surgery (Cuschieri, 1986;Heberer et al., 1988;Irvin and Bridger, 1988;Heesakkers et al., 1994), perhaps because of uncertainty regarding improvement in the survival rate and the high operative risk associated with extensive lymph node dissection (Dent et al., 1988;Heberer et al., 1988;Irvin and Bridger, 1988).To evaluate the therapeutic value of extensive lymphadenectomy in EGC, we analysed retrospectively the causes of death after surgery and compared the 10 year disease-specific survival rate in patients who had received extensive lymphadenectomy with patients who had received simple gastric resection. (LLND). ELND was performed beginning in September 1972. The LLND group consisted of 68 patients before September 1972 and 29 patients after. Each surgical procedure is outlined below. The subjects were followed up, and the effect of lymph node dissection on their 10 year disease-specific survival was evaluated. The operative and pathological findings were assessed according to the guidelines of the Japanese Research Society for Gastric Cancer (1981). The median age of the patients at the time of operation was 59 years, with a range of 18-84 years. There were 271 males (69%) and 121 females (31%). SurgeryThe ELND gastrectomy was performed as follows: the entire greater omentum, superior leaf of the mesocolon, pancreatic capsule and lesser omentum were removed en bloc with the cancerous distal portion of the stomach. Each of the supplying gastric arteries was ligated and divided at its origin, and the group 1 lymph nodes (nl), namely those along the lesser and greater curvatures, as well as the supra-and infra-pyloric lymph nodes, were completely dissected. In addition, the group 2 lymph nodes (n2) located at the...

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Section: Survivalmentioning

confidence: 99%

Section: Survivalmentioning

confidence: 99%

Rationale for extensive lymphadenectomy in early gastric carcinoma

Miwa

Miyazaki²,

Sahara³

et al. 1995

Br J Cancer

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“…In Japan, the incidence of gastric cancer invading the muscularis propria (pm gastric cancer) accounts for about 10% of all patients with gastric cancer undergoing surgical resection [1,2]. The pm gastric cancer is usually treated by curative resection [3], and the 5-year survival rate for patients with pm gastric cancer was reported to be between 70% and 80%, a value between that for EGC and AGC [4,5]. Although pm gastric cancer belongs to the category of AGC, it is considered to be an intermediate stage between EGC and AGC [6], and the biological characteristics of pm gastric cancer are different from those of AGC [7].…”

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Prediction of recurrence after curative resection of gastric carcinoma invading the muscularis propria: a multivariate analysis

et al. 2000

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and early gastric cancer (EGC) as that confined to the mucosa or submucosa, regardless of the presence or absence of lymph node metastases. In Japan, the incidence of gastric cancer invading the muscularis propria (pm gastric cancer) accounts for about 10% of all patients with gastric cancer undergoing surgical resection [1,2]. The pm gastric cancer is usually treated by curative resection [3], and the 5-year survival rate for patients with pm gastric cancer was reported to be between 70% and 80%, a value between that for EGC and AGC [4,5]. Although pm gastric cancer belongs to the category of AGC, it is considered to be an intermediate stage between EGC and AGC [6], and the biological characteristics of pm gastric cancer are different from those of AGC [7].Recurrences of gastric cancer are likely to take a variety of forms and to be manifested in different organs, and the rate of recurrence increases in proportion to the degree of depth of invasion, even after curative resection for gastric cancer [8][9][10]. Although many prognostic factors for EGC and AGC have been identified [9,11], there are few reports concerning prognostic factors for pm gastric cancer, and the characteristics of recurrence are not well understood. For early detection and more effective treatment of recurrent disease, it is important to fully understand the relevant characteristics. We examined the clinicopathological characteristics of patients with pm gastric cancer in relation to recurrence. Patients and methods PatientsFrom 1965 to 1998, curative resection for 2437 Japanese patients with primary gastric cancer was done at the Second Department of Surgery at Kyushu University Hospital (Fukuoka, Japan). The present study is based Abstract Background. In Japan, the incidence of gastric cancer invading the muscularis propria is about 10% of all patients with gastric cancer undergoing surgical resection. Although many prognostic factors for early gastric cancer and advanced gastric cancer have been identified, there are few reports concerning prognostic factors for gastric cancer invading the muscularis propria, and the characteristics of recurrence are not well understood. Methods. We retrospectively analyzed data on 167 patients with gastric cancer that had invaded the muscularis propria. All patients had undergone curative resection. Results. Recurrences were evident in 37 patients (22.2%). Based on our univariate analysis, the recurrence was associated with lymph node metastases. Multivariate analysis showed that independent risk factors for recurrence were lymph node metastases and location of tumor in the upper or lower one-third of the stomach. With respect to the pattern of recurrence, 17 (46.0%) were secondary to hematogenous recurrence, 8 (21.6%) to peritoneal dissemination, and 6 (16.2%) to a local recurrence in the remnant stomach and in regional lymph nodes. Most deaths occurred during the second year after surgery, and approximately two-thirds of all patients (64.8%) died within 3 years after surgery. Conclusion. In patients ...

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“…A principal indicação para pesquisa do linfonodo sentinela em câncer gástrico parece ser em tumores precoces T1, devido às baixas probabilidades de metástases para linfonodos 5,[15][16][17][18] . No entanto, nenhuma publicação relata restrição do seu uso em tumores avançados (T2,T3), apenas deve-se ter idéia de que quanto maior o grau de invasão tumoral maiores as chances de casos com LFNsn falso negativo 12 . Os dois tumores nos quais é realizada a pesquisa do LFNsn, com resultados satisfatórios, são o melanoma e o câncer de mama [19][20][21] .…”

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“…2007; 34(6): 367-373 Os três métodos para se realizar a pesquisa do linfonodo sentinela em câncer gástrico utilizam: o corante isolado, o radiotraçador isolado e a combinação de ambos 11,13 . A principal indicação para pesquisa do linfonodo sentinela em câncer gástrico parece ser em tumores precoces T1, devido às baixas probabilidades de metástases para linfonodos 5,[15][16][17][18] . No entanto, nenhuma publicação relata restrição do seu uso em tumores avançados (T2,T3), apenas deve-se ter idéia de que quanto maior o grau de invasão tumoral maiores as chances de casos com LFNsn falso negativo 12 .…”

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Pesquisa do linfonodo sentinela em câncer gástrico com o corante azul patente

Boff

Schirmer

Edelweiss

et al. 2007

Rev. Col. Bras. Cir.

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RESUMO: Objetivo: Avaliar a factibilidade e os resultados de uma técnica pouco invasiva para a pesquisa do linfonodo sentinela (LFNsn) com o uso do corante vital azul patente. Método: A pesquisa do LFNsn foi realizada em 12 pacientes portadores de adenocarcinoma gástrico que não apresentavam linfonodos suspeitos de metastases durante o estadiamento clínico pré-operatório. Injetou-se nos quatro quadrantes do tumor, 0,5 ml de corante vital azul patente. Os linfonodos que se coraram de azul foram classificados como LFNsn e foram obtidos após a gastrectomia com linfadenectomia D2. Utilizou-se a coloração HE para avaliação anatomopatológica dos LFNsn, e nos casos com LFNsn negativo para HE, foi realizada imuno-histoquímica com pan-citoqueratinas AE1/AE3. Resultados: Dos 12 pacientes, oito eram mulheres, com média de idade de 64,5 (48-87) anos. Identificaram-se em média 3,25 (2-6) LFNsn por paciente. A factibilidade da técnica foi de 100%. A acurácia do método foi de 91,6% . Em 11 de 12 casos foi possível predizer as características linfonodais regionais pela concordância da análise anatomopatológica entre os LFNsn e não sentinelas(LFNñsn). Conclusão: A pesquisa do linfonodo sentinela em câncer gástrico é factível com o uso da técnica do corante azul patente. O método mostrou ser promissor como técnica minimamente invasiva para estadiar tumores gástricos, nesta casuística inicial (Rev. Col. Bras. Cir. 2007; 34(6): 367-373 Os três métodos para se realizar a pesquisa do linfonodo sentinela em câncer gástrico utilizam: o corante isolado, o radiotraçador isolado e a combinação de ambos 11,13 . A principal indicação para pesquisa do linfonodo sentinela em câncer gástrico parece ser em tumores precoces T1, devido às baixas probabilidades de metástases para linfonodos 5,[15][16][17][18] . No entanto, nenhuma publicação relata restrição do seu uso em tumores avançados (T2,T3), apenas deve-se ter idéia de que quanto maior o grau de invasão tumoral maiores as chances de casos com LFNsn falso negativo 12 .Os dois tumores nos quais é realizada a pesquisa do LFNsn, com resultados satisfatórios, são o melanoma e o câncer de mama [19][20][21] . A técnica da pesquisa do linfonodo sentinela caracteriza-se principalmente em poder predizer com um alto percentual de acerto quais são as características dos demais linfonodos regionais, sendo importantíssima para estadiar estes tumores [22][23][24] .Para avaliar a factibilidade e os resultados de uma técnica pouco invasiva para a pesquisa do linfonodo sentinela (LFNsn) com o uso do corante vital azul patente, decidimos realizar um estudo clínico em pacientes portadores de câncer gástrico em nosso meio. MÉTODOO estudo foi realizado em 12 pacientes portadores de adenocarcinoma gástrico no Hospital de Clínicas de Porto Alegre e em casos privados do autor, no período de junho de 2002 a dezembro de 2004.Os critérios de inclusão foram os seguintes: adenocarcinoma gástrico localizado no fundo, corpo ou antro, lesões T1,T2 e T3, linfonodos regionais sem evidência de metástases no estadiamento clín...

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Is Extensive Lymphadenectomy Necessary for Surgical Treatment of Intramucosal Carcinoma of the Stomach?

Cited by 85 publications

References 6 publications

Rationale for extensive lymphadenectomy in early gastric carcinoma

Rationale for extensive lymphadenectomy in early gastric carcinoma

Prediction of recurrence after curative resection of gastric carcinoma invading the muscularis propria: a multivariate analysis

Pesquisa do linfonodo sentinela em câncer gástrico com o corante azul patente

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