AIM: To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemicaUy detected skip micrometastases in level 11 lymph nodes. METHODS: Among 95 gastric cancer patients who were routine...AIM: To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemicaUy detected skip micrometastases in level 11 lymph nodes. METHODS: Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0. All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the level Ⅰ lymph node stations (n = 4) were excluded from further analysis. The level 11 lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS: Skip micrometastases in the level Ⅱ lymph nodes were detected in 14% (4 out of 28) of the patients. The incidence was further increased to 17% (4 out of 24) in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No. 7 lymph node station. Thus, the disease was upstaged from stage Ⅰ A to Ⅰ B in one patient and from stage Ⅰ B to Ⅱ in three patients. CONCLUSION: In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.展开更多
文摘AIM: To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemicaUy detected skip micrometastases in level 11 lymph nodes. METHODS: Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0. All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the level Ⅰ lymph node stations (n = 4) were excluded from further analysis. The level 11 lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS: Skip micrometastases in the level Ⅱ lymph nodes were detected in 14% (4 out of 28) of the patients. The incidence was further increased to 17% (4 out of 24) in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No. 7 lymph node station. Thus, the disease was upstaged from stage Ⅰ A to Ⅰ B in one patient and from stage Ⅰ B to Ⅱ in three patients. CONCLUSION: In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.