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

 Baek-hui Kim  ;  Soon Won Hong  ;  Jong Won Kim  ;  Seung Ho Choi  ;  Sun Och Yoon 
 ANNALS OF SURGICAL ONCOLOGY, Vol.21(2) : 533-538, 2014 
Journal Title
Issue Date
Adenocarcinoma/metabolism ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery* ; Biomarkers, Tumor/metabolism ; Female ; Follow-Up Studies ; Gastrectomy* ; Humans ; Immunoenzyme Techniques ; Lymph Node Excision ; Lymph Nodes/metabolism ; Lymph Nodes/pathology ; Lymph Nodes/surgery* ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Micrometastasis ; Neoplasm Staging ; Organ Sparing Treatments* ; Prognosis ; Pylorus/metabolism ; Pylorus/pathology ; Pylorus/surgery* ; Stomach Neoplasms/metabolism ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery*
Lymph Node ; Early Gastric Cancer ; Metastatic Lymph Node ; Middle Portion ; Isolate Tumor Cell
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
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Won(김종원)
Yoon, Sun Och(윤선옥) ORCID logo https://orcid.org/0000-0002-5115-1402
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0002-9872-3594
Hong, Soon Won(홍순원) ORCID logo https://orcid.org/0000-0002-0324-2414
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