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Lymph node retrieval in radical gastrectomy: the pathologist alone or the surgeon-pathologist team?
Leonardo S Lino-Silva1, Hortencia E Mendoza-Lara1, Alberto M León-Takahashi2
1Department of Surgical Pathology, Instituto Nacional de Cancerología, Tlalpan, Mexico City, Mexico.
Przeglad Gastroenterologiczny
|September 29, 2021
Summary
Separating lymph nodes (LNs) in the operating room before pathology dissection significantly increases the total LN count in gastric cancer surgery. However, this method does not affect patient survival rates.
Area of Science:
- Oncology
- Surgical Pathology
Background:
- Lymph node (LN) dissection is a critical prognostic indicator in gastric cancer management.
- Limited data exists comparing LN counts based on dissection location: operating room versus pathology laboratory.
Purpose of the Study:
- To determine if the method of lymph node dissection impacts the total number of dissected nodes in gastric cancer patients.
- To compare lymph node counts obtained when dissection begins in the operating room versus solely in the pathology lab.
Main Methods:
- Prospective evaluation of 83 consecutive gastrectomies with D2 dissection between 2015-2017.
- Two protocols were compared: 1) surgeon pre-dissects LN levels in the OR, sending tissue separately; 2) standard protocol with pathologist dissecting LNs from submitted tissue.
- Analysis focused on the total number of lymph nodes recovered.
Main Results:
- The median LN count was significantly higher when dissection was initiated in the operating room (56 nodes) compared to dissection solely in the pathology lab (39 nodes) (p=0.005).
- Patient survival rates were comparable between the two dissection protocols, with median survival of 48 months and 43 months, respectively (p=0.316).
Conclusions:
- Pre-operative lymph node level separation in the operating room leads to a higher final lymph node count.
- This increased count does not appear to influence patient survival, likely due to sufficient node retrieval and high surgical quality in both groups.
