title: Ex Vivo Lymphadenectomy During Gastrectomy for Adenocarcinoma Optimizes Lymph Node Yield.
abstract: BACKGROUND
  Variability in surgical and pathological techniques in Western centers may lead to inconsistency in lymph node staging in patients with gastric adenocarcinoma. We hypothesize that ex vivo dissection (EVD) after gastrectomy for adenocarcinoma increases lymph node yield.
  
  
  METHODS
  We retrospectively reviewed 222 consecutive patients who underwent gastrectomy with curative intent for adenocarcinoma between November 2010 and June 2014. In August of 2012, we began performing EVD of nodes in surgical specimens (EVD group, N = 111), as opposed to submitting specimens en bloc with lymph node basins attached to the specimen (No EVD group, N = 111). Primary end point was lymph node yield.
  
  
  RESULTS
  The median number of lymph nodes procured was significantly higher in the EVD compared to that in the No EVD group (30 vs. 21 lymph nodes, respectively; P < 0.0001). Moreover, 28% of the No EVD group were not adequately staged (defined by ≤15 nodes), compared to 5% of the EVD group (P < 0.0001). Stage-for-stage overall survival was not significantly different.
  
  
  CONCLUSIONS
  EVD may be a useful tool to maximize lymph node yield. However, this had no impact on staging or survival. This is an interesting finding that warrants further investigation.
authors.affiliation: Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, H-1217, New York, NY, 10065, USA.|Department of Surgery, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, 10065, USA.
authors.forename: Cheguevara
authors.initials: C
authors.lastname: Afaneh
authors.affiliation: Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, H-1217, New York, NY, 10065, USA.|Department of Surgery, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, 10065, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Levy
authors.affiliation: Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, H-1217, New York, NY, 10065, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Selby
authors.affiliation: Gastric and Mixed Tumor Service, Department of Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, 10065, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Ku
authors.affiliation: Gastric and Mixed Tumor Service, Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, 10065, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Tang
authors.affiliation: Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, H-1217, New York, NY, 10065, USA.
authors.forename: Sam S
authors.initials: SS
authors.lastname: Yoon
authors.affiliation: Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, H-1217, New York, NY, 10065, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Coit
authors.affiliation: Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, H-1217, New York, NY, 10065, USA. strongv@mskcc.org.
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Strong
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D004210:Dissection; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Ex vivo dissection; Gastrectomy; Gastric cancer; Lymph node; Staging