Routine modified D2 lymphadenectomy performance in pT1-T2N0 gastric cancer.
OBJECTIVE
To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemically detected skip micrometastases in level II 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 II 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 IA to IB in one patient and from stage IB to II in three patients.


CONCLUSIONS
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.
Griniatsos
John
J
1st Department of Surgery, University of Athens, Medical School, LAIKO Hospital, Athens, Greece. johngriniatsos@yahoo.com
Gakiopoulou
Hara
H
Yiannakopoulou
Eugenia
E
Dimitriou
Nikoletta
N
Douridas
Gerasimos
G
Nonni
Afrodite
A
Liakakos
Theodoros
T
Felekouras
Evangelos
E
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology*; D000368:Aged; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome