Skip to main content

Advertisement

SpringerLink
Log in

How Should We Measure the Quality of Lymphadenectomy for Gastric Cancer? Anatomical Versus Numerical Criterion

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Aim

To compare anatomical with numerical criterion to measure the quality of lymphadenectomy for gastric cancer.

Patients and Methods

We analyzed 447 gastric cancer patients with resectable tumor stage (R0 resection) with at least 16 examined lymph nodes.

Results

Of 447 patients, 82.6% underwent D2 lymphadenectomy for a median of total examined lymph nodes of 28. The 7-year disease-specific survival rate for the whole sample was 71.4%. Survival was significantly different between patients treated with D2 and D1 lymphadenectomy (77.4% versus 44.3%; p < 0.001) and between patients with total examined lymph nodes ≥ 28 and < 28 (74.5% versus 62.3%; p = 0.041). Anatomical criterion significantly differentiated 7-year survival in patients stratified according to a numerical parameter.

Conclusion

We should still consider the anatomical criterion as the best item to measure the quality of lymphadenectomy for gastric cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Qiu MZ, Qiu HJ, Wang ZQ, Ren C, Wang DS, Zhang DS, et al. The tumor - log odds of positive lymph nodes-metastasis staging system, a promising new staging system for gastric cancer after D2 resection in China. PLoS One. 2012;7(2):e31736.

    Article  CAS  Google Scholar 

  2. Chen HN, Chen XZ, Zhang WH, et al. Necessity of harvesting at least 25 lymph nodes in patients with stage N2–N3 resectable gastric cancer. A 10-year, single-institution cohort study. Medicine. 2015;94(10):e620.

    Article  Google Scholar 

  3. Tanizawa Y, Terashima M. Lymph node dissection in the resection of gastric cancer: review of existing evidence. Gastric Cancer. 2010;13:137–48.

    Article  Google Scholar 

  4. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, et al. Nodal dissection for patients with gastric cancer: a randomized controlled trial. Lancet Oncol. 2006;7:309–15.

    Article  CAS  Google Scholar 

  5. Wu CW, Hsiung CA, Lo SS. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg. 2004;91:283–7.

    Article  CAS  Google Scholar 

  6. Lu J, Wang W, Zheng CH, et al. Influence of total lymph node count on staging and survival after gastrectomy for gastric cancer: an analysis from a two-institution database in China. Ann Surg Oncol. 2017;24:486–93.

    Article  Google Scholar 

  7. Japanese Gastric Cancer Association Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017; 20(1):1-19.

  8. Giuliani A, Miccini M, Basso L. Extent of lymphadenectomy and perioperative therapies: two open issues in gastric cancer. World J Gastroenterol. 2014;20(14):3889–904.

    Article  Google Scholar 

  9. Deng J, Zhang R, Pan Y, Wang B, Wu L, Hao X, et al. N stages of the seventh edition of TNM classification are the most intensive variables for predictions of the overall survival of gastric cancer patients who underwent limited lymphadenectomy. Tumor Biol. 2014;35(4):3269–81.

    Article  CAS  Google Scholar 

  10. Karpeh MS, Leon L, Klimstra D, Brennan MF. Lymph node staging in gastric cancer: is location more important than number? An analysis of 1.038 patients. Ann Surg. 2000;232(3):362–71.

    Article  CAS  Google Scholar 

  11. Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005;23:7114–24.

    Article  Google Scholar 

  12. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long term results of the MRC randomized surgical trial. Surgical co-operative Group. Br J Cancer. 1999;79:1522–30.

    Article  CAS  Google Scholar 

  13. Rausei S, Dionigi G, Sano T, et al. Updates on surgical management of advanced gastric cancer: new evidence and trends. Insights from the first international course on upper gastrointestinal surgery--Varese (Italy), December 2, 2011. Ann Surg Oncol. 2013;20(12):3942–7.

    Article  Google Scholar 

  14. Degiuli M, Sasako M, Ponti A, et al. Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study. J Clin Oncol. 1998;16:1490–3.

    Article  CAS  Google Scholar 

  15. Barreto SG, Sirohi B. Why should we perform a D2 lymphadenectomy in gastric cancer? Future Oncol. 2017;13(23):2009–12.

    Article  CAS  Google Scholar 

  16. Rausei S, Dionigi G, Boni L, Rovera F, Dionigi R. How does the 7th TNM edition fit in gastric cancer management? Ann Surg Oncol. 2011;18(5):1219–21.

    Article  Google Scholar 

  17. Ahn HS, Lee HJ, Hahn S, Kim WH, Lee KU, Sano T, et al. Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 2010;116(24):5592–8.

    Article  Google Scholar 

  18. Sobin LH, Wittekind CH, editors. TNM classification of malignant tumors. 6th ed. New York: Wiley; 2002.

    Google Scholar 

  19. Greene FL, Page DL, Fleming ID, et al., editors. AJCC cancer staging manual: TNM classification of malignant tumors. 6th ed. New York: Springer-Verlag; 2002.

    Google Scholar 

  20. In H, Solsky I, Palis B, et al. Validation of the 8th edition of the AJCC TNM staging system for gastric cancer using the national cancer database. Ann Surg Oncol. 2017;11:1–9.

    Google Scholar 

  21. Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  22. Gholami S, Janson L, Worhunsky DJ, et al. Number of lymph nodes removed and survival after gastric cancer resection: an analysis from the US gastric cancer collaborative. J Am Coll Surg. 2015;21:291–9.

    Article  Google Scholar 

  23. Schwarz REI, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2006;14:317–8.

    Article  Google Scholar 

  24. Bunt AM, Hermans J, Boon MC, van de Velde C, Sasako M, Fleuren GJ, et al. Evaluation of the extent of lymphadenectomy in a randomized trial of Western-versus Japanese-type surgery in gastric cancer. J Clin Oncol. 1994;12(2):417–22.

    Article  CAS  Google Scholar 

  25. Chen T, Yan D, Zheng Z, et al. Evolution in the surgical management of gastric cancer: is extended lymph node dissection back in vogue in the USA? World J Surg Oncol. 2017;15:135.

    Article  Google Scholar 

  26. Chon SH, Berlth F, Plum PS, et al. Gastric cancer treatment in the world: Germany. Transl Gastroenterol Hepatol. 2017;2:53.

    Article  Google Scholar 

  27. Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol. 2002;9(8):775–84.

    Article  Google Scholar 

  28. Nitti D, Marchet A, Olivieri M. Ratio between metastatic and examined lymph node is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitution experience. Ann Surg Oncol. 2003;2(5):S54–7.

    Google Scholar 

  29. Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, et al. The ratio between metastatic and examined lymph nodes is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy. Ann Surg. 2007;245:543–52.

    Article  Google Scholar 

  30. Xu D, Geng Q, Long Z, Zhan YQ, Li W, Zhou ZW, et al. Positive lymph node ratio is an independent prognostic factor in gastric cancer after D2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol. 2009;16:319–26.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, ASST Valle Olona, Gallarate, VA, Italy

    Stefano Rausei

  2. Department of Surgery, University of Insubria, Varese, Italy

    Federica Galli & Francesco Martignoni

  3. Department of Surgery, University Hospital of Ioannina, Ioannina, Greece

    Georgios Lianos

  4. Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy

    Fausto Rosa & Sergio Alfieri

  5. Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy

    Andrea Cossu & Riccardo Rosati

  6. Division of General Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy

    Alberto Biondi, Roberto Persiani & Domenico D’Ugo

  7. Division of Surgical Oncology, Humanitas Clinical and Research Center, Rozzano, MI, Italy

    Ferdinando Carlo Maria Cananzi & Vittorio Quagliuolo

  8. Department of Surgery, Brescia University, Brescia, Italy

    Uberto Fumagalli

Authors
  1. Stefano Rausei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Federica Galli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georgios Lianos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fausto Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Cossu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alberto Biondi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesco Martignoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ferdinando Carlo Maria Cananzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Uberto Fumagalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sergio Alfieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Roberto Persiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Vittorio Quagliuolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Domenico D’Ugo
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Riccardo Rosati
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georgios Lianos.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Highlights

• There is no reliable criteria to evaluate the quality of lymphadenectomy for gastric cancer.

• In this multicenter study, we analyzed a large cohort of selected gastric cancer patients to compare anatomical with numerical criterion to measure the quality of the lymphadenectomy.

• Seven-year survival was significantly different between patients treated with D2 and D1 lymphadenectomy and between patients with ≥ 28 and < 28 total examined lymph nodes, but the anatomical criterion was more effective to significantly differentiated patients survival.

• Numerical criterion is too variable to be considered reliable in the evaluating (in a “post hoc” phase) the quality of lymphadenectomy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rausei, S., Galli, F., Lianos, G. et al. How Should We Measure the Quality of Lymphadenectomy for Gastric Cancer? Anatomical Versus Numerical Criterion. J Gastrointest Canc 51, 887–892 (2020). https://doi.org/10.1007/s12029-019-00321-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-019-00321-x

Keywords

Search

Navigation