Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma

2017 ◽  
Author(s):  
Sam S. Yoon ◽  
Kevin K. Chang
Keyword(s):  
Lymph Node ◽  
Gastric Adenocarcinoma ◽  
Gastric Resection ◽  
Nodal Metastasis ◽  
Current Evidence ◽  
Lymph Node Staging ◽  
Curative Therapy ◽  
Key Words Gastrectomy ◽  
Locoregional Lymph Node ◽  
The Ideal

Gastric adenocarcinoma is one of the most common and lethal cancers worldwide and is associated with a high frequency of nodal metastasis. The value of multimodality therapy is well established, but gastric resection and locoregional lymph node dissection are important mainstays in potentially curative therapy. However, there has been considerable regional variation in surgical approach and debate regarding the ideal extent of gastric resection, gastric reconstruction, and extent of lymphadenectomy. This review outlines the current evidence in the surgical management of gastric adenocarcinoma. The advent of minimally invasive approaches to gastric operations is also discussed. This review contains 4 figures, 7 tables, and 50 references. Key words: gastrectomy, gastric cancer, lymphadenectomy, lymph node, lymph node staging, stomach

Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma

2017 ◽  
Author(s):  
Sam S. Yoon ◽  
Kevin K. Chang
Keyword(s):  
Lymph Node ◽  
Gastric Adenocarcinoma ◽  
Gastric Resection ◽  
Nodal Metastasis ◽  
Current Evidence ◽  
Lymph Node Staging ◽  
Curative Therapy ◽  
Key Words Gastrectomy ◽  
Locoregional Lymph Node ◽  
The Ideal

Gastric adenocarcinoma is one of the most common and lethal cancers worldwide and is associated with a high frequency of nodal metastasis. The value of multimodality therapy is well established, but gastric resection and locoregional lymph node dissection are important mainstays in potentially curative therapy. However, there has been considerable regional variation in surgical approach and debate regarding the ideal extent of gastric resection, gastric reconstruction, and extent of lymphadenectomy. This review outlines the current evidence in the surgical management of gastric adenocarcinoma. The advent of minimally invasive approaches to gastric operations is also discussed. This review contains 4 figures, 7 tables, and 50 references. Key words: gastrectomy, gastric cancer, lymphadenectomy, lymph node, lymph node staging, stomach

Prognostic Performance of Different Lymph Node Staging Systems After Curative Intent Resection for Gastric Adenocarcinoma

2015 ◽  
Vol 262 (6) ◽  
pp. 991-998 ◽  
Author(s):  
Gaya Spolverato ◽  
Aslam Ejaz ◽  
Yuhree Kim ◽  
Malcolm H. Squires ◽  
George Poultsides ◽  
...  
Keyword(s):  
Lymph Node ◽  
Gastric Adenocarcinoma ◽  
Lymph Node Staging ◽  
Curative Intent ◽  
Prognostic Performance ◽  
Staging Systems

scholarly journals Computed tomography with a stomach protocol and virtual gastroscopy in the staging of gastric cancer: an initial experience

2018 ◽  
Vol 51 (4) ◽  
pp. 211-217 ◽  
Author(s):  
Maria Fernanda Arruda Almeida ◽  
Leonardo Verza ◽  
Almir Galvão Vieira Bitencourt ◽  
Camila Silva Boaventura ◽  
Paula Nicole Vieira Pinto Barbosa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Computed Tomography ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Multidetector Computed Tomography ◽  
Gastric Adenocarcinoma ◽  
Preoperative Staging ◽  
Lymph Node Staging ◽  
Virtual Gastroscopy ◽  
Staging Of Gastric Cancer

Abstract Objective: To evaluate the accuracy of multidetector computed tomography with a stomach protocol in staging of gastric cancer. Materials and Methods: We evaluated 14 patients who underwent computed tomography in a 16-channel scanner for preoperative staging of gastric adenocarcinoma between September 2015 and December 2016. All images were analyzed by the same radiologist, who had extensive experience in abdominal cancer imaging. The sensitivity, specificity, and accuracy of the method were calculated by comparing it with the pathology result. All patients underwent partial or total gastrectomy. Results: The mean age was 61.5 years, and 53.8% of the patients were male. The gastric lesions were classified as T1/T2 in 35.7% of the cases, as T3 in 28.5%, and as T4 in 35.7%. Eleven patients (68.7%) had suspicious (N positive) lymph nodes. The accuracy of the T1/T2, T3, T4, and lymph node staging tests was 85%, 78%, 90%, and 78%, respectively. The respective sensitivity and specificity values were 71% and 100% for T1/T2, 66% and 81% for T3, 100% and 90% for T4, and 88% and 60% for lymph nodes. Conclusion: Multidetector computed tomography with a stomach protocol, used in conjunction with virtual gastroscopy, shows good accuracy in the tumor and lymph node staging of gastric adenocarcinoma.

scholarly journals Linear Endobronchial Ultrasound in the Era of Personalized Lung Cancer Diagnostics—A Technical Review

2021 ◽  
Vol 10 (23) ◽  
pp. 5646
Author(s):  
Filiz Oezkan ◽  
Stephan Eisenmann ◽  
Kaid Darwiche ◽  
Asmae Gassa ◽  
David P. Carbone ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Cancer Diagnostics ◽  
Endobronchial Ultrasound ◽  
Current Evidence ◽  
Molecular Testing ◽  
Lymph Node Staging ◽  
Cancer Management ◽  
Targeted Treatments ◽  
Site Evaluation

Major advances in molecular profiling for available targeted treatments and immunotherapy for lung cancer have significantly increased the complexity of tissue-based diagnostics. Endobronchial ultrasound-guided transbronchial needle aspirations (EBUS-TBNA) are commonly performed for diagnostic biopsies and lymph node staging. EBUS-TBNA has increasingly become one of the main sources of tumor cells for molecular analyses. As a result, there is a growing need for high quality EBUS-TBNA samples with adequate cellularity. This has increased the technical demands of the procedure and has created additional challenges, many of which are not addressed in the current EBUS guidelines. This review provides an overview of current evidence on the technical aspects of EBUS-TBNA in light of comprehensive sample processing for personalized lung cancer management. These include sonographic lymph node characterization, optimal needle choice, suction biopsy technique, and the role of rapid on-site evaluation. Attention to these technical details will be important to maximize the throughput of EBUS-TBNA biopsies for molecular testing.

Sentinel Lymph Node Mapping for Gastric Adenocarcinoma

2009 ◽  
Vol 75 (8) ◽  
pp. 710-714 ◽  
Author(s):  
Robert D. Becher ◽  
Perry Shen ◽  
John H. Stewart ◽  
Kim R. Geisinger ◽  
Lezah P. Mccarthy ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Gastric Carcinoma ◽  
Gastric Adenocarcinoma ◽  
False Negative ◽  
Prospective Trial ◽  
Nodal Metastasis ◽  
Mapping Procedure ◽  
Regional Lymphadenectomy

The optimal extent of regional lymphadenectomy for gastric adenocarcinoma remains a controversial topic. Traditional approaches have focused on various anatomical nodal stations to define the extent of resection. In this prospective trial, we update our experience with sentinel lymph node (SLN) mapping and biopsy to augment resection of nodal metastasis in gastric carcinoma. Twenty-seven patients with gastric cancer were enrolled. SLNs were identified with isosulfan blue, resected, and sent fresh to pathology for staining and evaluation. The procedure then continued with radical gastrectomy and celiac node dissection. SLNs were identified in all cases. The average patient age was 65 years, with 12 women and 15 men. Eighteen patients had pathology-confirmed nodal metastasis. Positive SLN were found in 15 (83%); three patients had a false negative SLN mapping procedure (17%). Accuracy rate was 88.9 per cent. SLN mapping and biopsy for gastric carcinoma is feasible. However, the negative predictive value is 75 per cent, and therefore caution should be considered in using lymphatic mapping to determine extent of regional lymphadenectomy. Additionally, our study shows no utility in identifying micro-metastatic disease with immunohistochemical techniques. Although a promising modality, we do not recommend the clinical use of SLN mapping for gastric cancer.

Lymph node metastasis in early gastric adenocarcinoma in the United States of America

Endoscopy ◽  
2017 ◽  
Vol 50 (05) ◽  
pp. 479-486 ◽  
Author(s):  
Sridevi Pokala ◽  
Chao Zhang ◽  
Zhengjia Chen ◽  
Anthony Gamboa ◽  
Sarah Cristofaro ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Gastric Adenocarcinoma ◽  
Multivariable Analysis ◽  
Tumor Stage ◽  
The United States ◽  
Nodal Metastasis ◽  
Low Grade ◽  
Node Metastasis ◽  
The Us

Abstract Background and study aims Localized approaches are being increasingly used in the management of early gastric adenocarcinoma; however, there are limited data on lymph node metastasis in the US population. This study examined the incidence and predictors of lymph node involvement for early-stage gastric adenocarcinomas in the USA. Patients and methods Data were abstracted from the national SEER database from 2004 to 2013. Exclusion criteria included: cases with unknown tumor characteristics, unknown patient characteristics, metastatic disease, neoadjuvant radiation, and lack of surgical resection or lymph node evaluation. Univariate and multivariable analyses were conducted to assess the relationship of tumor stage, grade, and size, and patient sex, race, and age with nodal involvement. Results 43 769 cases of gastric adenocarcinoma were initially abstracted. After exclusions, 1577 patients remained for analysis. Multivariable analysis revealed that tumor stage (P < 0.001), grade (P = 0.008), and size (P < 0.001) were independent predictors of nodal metastasis. For low grade T1a tumors, nodal metastasis was present in 1.7 %, 1.7 %, 4.5 %, 4.1 %, and 20 % of tumors 0 – 1 cm, 1 – 2 cm, 2 – 3 cm, 3 – 4 cm, and ≥ 4 cm in size, respectively (P < 0.001), and in 8.4 %, 18.0 %, 19.5 %, 22.0 %, and 35.8 % of T1b tumors, respectively (P < 0.001). Conclusions Low grade T1a tumors < 4 cm in size have low rates of nodal metastasis in the US population and may warrant consideration for local resection. Larger, higher grade T1b tumors have high rates of nodal metastasis in the US population and lymph node dissection may be indicated for patients who are surgical candidates.

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