Clinical significance of lymphadenectomy in patients with gastric cancer

Approximately thirty percent of patients with gastric cancer undergo an avoidable lymph node dissection with a higher rate of postoperative complication. Comparing the D1 and D2 dissections,it was found that there is a significant difference in morbidity,favoured D1 dissection without any difference in overall survival. Subgroup analysis of patients with T3 tumor shows a survival difference favoring D2 lymphadenectomy,and there is a better gastric cancer-related death and non-statistically significant improvement of survival for node-positive disease in patients with D2 dissection. However,the extended lymphadenectomy could improve stage-specific survival owing to the stage migration phenomenon. The deployment of centralization and application of national guidelines could improve the surgical outcomes. The Japanese and European guidelines enclose the D2 lymphadenectomy as the gold standard in R0 resection. In the individualized,stageadapted gastric cancer surgery the Maruyama computer program(MCP) can estimate lymph node involvement preoperatively with high accuracy and in addition the Maruyama Index less than 5 has a better impact on survival,than D-level guided surgery. For these reasons,the preoperative application of MCP is recommended routinely,with an aim to perform "low Maruyama Index surgery". The sentinel lymph node biopsy(SNB) may decrease the number of redundant lymphadenectomy intraoperatively with a high detection rate(93.7%) and an accuracy of 92%. More accurate stage-adapted surgery could be performed using the MCP and SNB in parallel fashion in gastric cancer.

Comparison of different lymph node staging systems in prognosis of gastric cancer:a bi-institutional study from Hungary

Objective： The Union for International Cancer Control （UICC） Node （N） classification is the most common used staging method for the prognosis of gastric cancer. It demands adequate, at least 16 lymph nodes （LNs） to be dissected; therefore different staging systems were invented. Methods： Between March 2005 and March 2010, 164 patients were evaluated at the Department of General Surgery in the Ken^zy Gyula Hospital and at the Department of General, Thoracic and Vascular Surgery in the Kaposi M6r Hospital. The 6th, 7th and 8th UICC N-staging systems, the number of examined LNs, the number of harvested negative LNs, the metastatic lymph node ratio （MLR） and the log odds of positive LNs （LODDS） were determined to measure their 5-year survival rates and to compare them to each other. Results： The overall 5year survival rate for all patients was 55.5% with a median overall survival time of 102 months. The tumor stage, gender, UICC N-stages, MLR and the LODDS were significant prognostic factors for the 5-year survival with univariate analysis. The 6th UICC N-stage did not follow the adequate risk in comparing N2 vs. NO and N3 vs. NO with multivariate investigation. Comparison of performances of the residual N classifications proved that the LODDS system was first in the prediction of prognosis during the evaluation of all patients and in cases with less than 16 harvested LNs. The MLR gave the best prognostic prediction when adequate （more than or equal to 16） lymphadenectomy was performed. Conclusions： We suggest the application of LODDS system routinely in western patients and the usage of MLR classification in cases with extended lymphadenectomy.