title: Ex vivo dissection increases lymph node yield in oesophagogastric cancer.
abstract: BACKGROUND
  Retrieval and analysis of an adequate number of lymph nodes is critical for accurate staging of oesophageal and gastric cancer. Higher total node counts reported by pathologists are associated with improved survival. A prospective study was undertaken to understand the factors contributing to variability in lymph node counts after oesophagogastric cancer resections and to determine whether a novel strategy of ex vivo dissection of resected specimens into nodal stations improves node counts reported by pathologists.
  
  
  METHODS
  The study involved 88 patients with potentially curable oesophagogastric cancer undergoing radical resection. Lymph node counts were obtained from pathology reports and analysed in relation to multiple variables including the introduction of ex vivo dissection of nodal stations in theatre.
  
  
  RESULTS
  Higher lymph node counts were obtained with ex vivo dissection of nodal stations (median 19 versus 8, P < 0.01). Node counts also varied significantly with the reporting pathologist (median range 4 to 48, P = 0.02) which was independent of the level of experience of the pathologist (P = 0.67). Node counts were not affected by patient age (P = 0.26), gender (P = 0.50), operative approach (P = 0.50) or neoadjuvant therapy (P = 0.83).
  
  
  CONCLUSIONS
  Specimen handling is a significant factor in determining lymph node yield following radical oesophageal and gastric cancer resections. Ex vivo dissection of resected specimens into nodal stations improves node counts without alterations to surgical techniques. Ex vivo dissection should be considered routine.
authors: Department of General Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
authors: Adam
authors: A
authors: Cichowitz
authors: Paul
authors: P
authors: Burton
authors: Wendy
authors: W
authors: Brown
authors: Andrew
authors: A
authors: Smith
authors: Kalai
authors: K
authors: Shaw
authors: Ron
authors: R
authors: Slamowicz
authors: Peter D
authors: PD
authors: Nottle
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004210:Dissection / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: gastrectomy; lymph nodes; neoplasm staging; oesophagectomy; specimen handling