Skip to main content

Advertisement

SpringerLink
Log in

Oncologic Safety of Pylorus-preserving Gastrectomy in the Aspect of Micrometastasis in Lymph Nodes at Stations 5 and 6

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pylorus-preserving gastrectomy (PPG) is a function-preserving gastrectomy for early gastric cancers (EGCs) that are preoperatively assessed as pN0 tumors and located in the middle portion of the stomach. In PPG, dissection of the lymph nodes at stations 5 and 6 is frequently incomplete, and this may be worrisome in terms of oncologic safety.

Methods

We examined lymph nodes collected from stations 5 and 6 from 196 patients who had undergone conventional distal gastrectomy (CDG) for EGC located in the middle portion of the stomach and from 24 patients who had undergone PPG.

Results

The average number of lymph nodes collected at station 5 was significantly lower with PPG than with CDG (0.08 vs. 1.32, respectively; P = 0.008). However, such a difference was not noted for station 6 nodes. The rate of macrometastasis was very low in all station 5 nodes (1 of 220, 0.45 %) and station 6 nodes (1 of 220, 0.45 %). Immunohistochemical analysis of cytokeratin in 109 cases of the CDG group and 21 cases of the PPG group showed that micrometastasis of single isolated tumor cell type was observed in only one station 6 lymph node of a patient who was initially diagnosed with pN0 EGC. There were no cases of micrometastasis in station 5 nodes.

Conclusions

The possibility of micrometastasis to station 5 and/or 6 lymph nodes may be negligible for EGC located in the middle portion of the stomach, and PPG thus might be the oncologically safe procedure when considering micrometastasis in remaining nodes in vivo at stations 5 and 6.

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. Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery. 1967;61:838–45.

    CAS  PubMed  Google Scholar 

  2. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

    Google Scholar 

  3. Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer. 2007;10:167–72.

    Article  PubMed  Google Scholar 

  4. Park do J, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008;32:1029–36.

    Article  PubMed  Google Scholar 

  5. Shibata C, Shiiba KI, Funayama Y, et al. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg. 2004;28:857–61.

    Article  PubMed  Google Scholar 

  6. Kong SH, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK. The safety of the dissection of lymph node stations 5 and 6 in pylorus-preserving gastrectomy. Ann Surg Oncol. 2009;16:3252–8.

    Article  PubMed  Google Scholar 

  7. Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg. 2008;95:1131–5.

    Article  CAS  PubMed  Google Scholar 

  8. Ikeguchi M, Hatada T, Yamamoto M, et al. Evaluation of a pylorus-preserving gastrectomy for patients preoperatively diagnosed with early gastric cancer located in the middle third of the stomach. Surg Today. 2010;40:228–33.

    Article  PubMed  Google Scholar 

  9. Nitti D, Marchet A, Olivieri M, et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol. 2003;10:1077–85.

    Article  PubMed  Google Scholar 

  10. Catalano V, Labianca R, Beretta GD, Gatta G, de Braud F, Van Cutsem E. Gastric cancer. Crit Rev Oncol Hematol. 2009;71:127–64.

    Article  PubMed  Google Scholar 

  11. Edge SB, American Joint Committee on Cancer. AJCC cancer staging manual. 7th edition. New York: Springer; 2010.

    Google Scholar 

  12. Aaltonen LA, Hamilton SR, World Health Organization, International Agency for Research on Cancer. Pathology and genetics of tumours of the digestive system. Oxford: IARC; 2000.

    Google Scholar 

  13. Arigami T, Uenosono Y, Yanagita S, et al. Clinical significance of lymph node micrometastasis in gastric cancer. Ann Surg Oncol. 2013;20:515–21.

    Article  PubMed  Google Scholar 

  14. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.

    Google Scholar 

  15. Rosai J, Ackerman LV. Rosai and Ackerman’s surgical pathology. 10th edition. New York: Mosby; 2011.

    Google Scholar 

  16. Cai J, Ikeguchi M, Maeta M, Kaibara N. Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer. Surgery. 2000;127:32–9.

    Article  CAS  PubMed  Google Scholar 

  17. Maehara Y, Oshiro T, Endo K, et al. Clinical significance of occult micrometastasis lymph nodes from patients with early gastric cancer who died of recurrence. Surgery. 1996;119:397–402.

    Article  CAS  PubMed  Google Scholar 

  18. Morgagni P, Saragoni L, Folli S, et al. Lymph node micrometastases in patients with early gastric cancer: experience with 139 patients. Ann Surg Oncol. 2001;8:170–4.

    Article  CAS  PubMed  Google Scholar 

  19. Choi HJ, Kim YK, Kim YH, Kim SS, Hong SH. Occurrence and prognostic implications of micrometastases in lymph nodes from patients with submucosal gastric carcinoma. Ann Surg Oncol. 2002;9:13–9.

    Article  PubMed  Google Scholar 

  20. Morgagni P, Saragoni L, Scarpi E, et al. Lymph node micrometastases in early gastric cancer and their impact on prognosis. World J Surg. 2003;27:558–61.

    Article  PubMed  Google Scholar 

  21. Miyake K, Seshimo A, Kameoka S. Assessment of lymph node micrometastasis in early gastric cancer in relation to sentinel nodes. Gastric Cancer. 2006;9:197–202.

    Article  PubMed  Google Scholar 

  22. Cao L, Hu X, Zhang Y, Huang G. Adverse prognosis of clustered-cell versus single-cell micrometastases in pN0 early gastric cancer. J Surg Oncol. 2011;103:53–6.

    Article  PubMed  Google Scholar 

  23. Han KB, Jang YJ, Kim JH, et al. Clinical significance of the pattern of lymph node metastasis depending on the location of gastric cancer. J Gastric Cancer. 2011;11:86–93.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Pantel K, Brakenhoff RH, Brandt B. Detection, clinical relevance and specific biological properties of disseminating tumour cells. Nat Rev Cancer. 2008;8:329–40.

    Article  CAS  PubMed  Google Scholar 

  25. Weaver DL, Ashikaga T, Krag DN, et al. Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364:412–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Kunisaki C, Akiyama H, Nomura M, et al. Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol. 2006;13:363–9.

    Article  PubMed  Google Scholar 

  27. Nomura S, Kaminishi M. Surgical treatment of early gastric cancer. Dig Surg. 2007;24:96–100.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by a faculty research grant of Yonsei University College of Medicine for 2010 (6-2010-0109).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

    Baek-hui Kim MD, PhD

  2. Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Soon Won Hong MD, PhD & Sun Och Yoon MD, PhD

  3. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Jong Won Kim MD, PhD & Seung Ho Choi MD, PhD

Authors
  1. Baek-hui Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soon Won Hong MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jong Won Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seung Ho Choi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sun Och Yoon MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sun Och Yoon MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, Bh., Hong, S.W., Kim, J.W. et al. Oncologic Safety of Pylorus-preserving Gastrectomy in the Aspect of Micrometastasis in Lymph Nodes at Stations 5 and 6. Ann Surg Oncol 21, 533–538 (2014). https://doi.org/10.1245/s10434-013-3252-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3252-7

Keywords

Search

Navigation