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Surgeon-Pathologist Team Approach Dramatically Affects Lymph Nodes Detection and Improves Patients' Short-Term
Maria Raffaella Ambrosio1, Bruno Perotti2, Alda Battini2
1Pathology Unit, Azienda Sanitaria Toscana Nord-Ovest, Via Cocchi 1, 56121 Pisa, Italy.
Abstract:
The downstaging of gastric cancer has recently gained particular attention in the field of gastric cancer surgery. The phenomenon is mainly due to an inappropriate sampling of lymph nodes during standard lymphadenectomy. Hence, collection of the maximum number of lymph nodes is a critical factor affecting the outcome of patients. None of the techniques proposed so far have demonstrated a real efficiency in increasing the number of identified lymph nodes. To harvest the maximum number of lymph nodes, we designed a protocol for on-site macroscopic evaluation and sampling of lymph nodes according to the Japanese Gastric Cancer Association protocol. The procedure was carried out by a surgeon/pathologist team in the operating room. We enrolled one hundred patients, 50 of whom belonged to the study group and 50 to a control group. The study group included patients who underwent lymph node dissection following the proposed protocol; the control group encompassed patients undergoing standard procedures for sampling. We compared the number and maximum diameter of lymph nodes collected in both groups, as well as some postoperative variables, the 30-day mortality and the overall survival. In the study group, the mean number of lymph nodes harvested was higher than the control one (p = 0.001). Moreover, by applying the proposed technique, we sampled lymph nodes with a very small diameter, some of which were metastatic. Noticeably, no difference in terms of postoperative course was identified between the two groups, again supporting the feasibility of an extended lymphadenectomy. By comparing the prognosis of patients, a better overall survival (p = 0.03) was detected in the study group; however, to date, no long-term follow-up is available. Interestingly, patients with metastasis in node stations number 8, 9, 11 or with skip metastasis, experienced a worse outcome and died. Based on our preliminary results, the pathologist/surgeon team approach seems to be a reliable option, despite of a slight increase in sfaff workload and technical cost. It allows for the harvesting of a larger number of lymph nodes and improves the outcome of the patients thanks to more precise staging and therapy. Nevertheless, since a higher number of patients are necessary to confirm our findings and assess the impact of this technique on oncological outcome, our study could serve as a proof-of-concept for a larger, multicentric collaboration.
Insights
A new surgeon/pathologist team protocol significantly increased lymph node recovery in gastric cancer surgery, improving patient staging and survival. This method enhances lymph node sampling for better oncological outcomes.
Area of Science:
- Surgical Oncology
- Pathology
- Gastroenterology
Background:
- Gastric cancer downstaging is crucial for accurate treatment.
- Inadequate lymph node sampling during surgery limits precise staging.
- Current methods for increasing lymph node yield lack proven efficiency.
Purpose of the Study:
- To evaluate a novel on-site macroscopic evaluation and sampling protocol for lymph nodes in gastric cancer surgery.
- To compare the effectiveness of the new protocol against standard lymphadenectomy in terms of lymph node yield and patient outcomes.
Main Methods:
- A prospective study involving 100 gastric cancer patients, divided into a study group (n=50) and a control group (n=50).
- The study group underwent lymph node dissection using a surgeon/pathologist team protocol based on the Japanese Gastric Cancer Association guidelines.
- The control group received standard lymphadenectomy procedures.
- Comparison of harvested lymph node number, maximum diameter, postoperative variables, 30-day mortality, and overall survival between groups.
Main Results:
- The study group yielded a significantly higher mean number of lymph nodes compared to the control group (p=0.001).
- The protocol successfully identified small metastatic lymph nodes, including those in critical stations (8, 9, 11) and skip metastases.
- No significant differences were observed in postoperative course or 30-day mortality between the groups.
- A trend towards better overall survival was noted in the study group (p=0.03), though long-term data is pending.
Conclusions:
- The surgeon/pathologist team approach for on-site lymph node evaluation is feasible and effective in increasing lymph node harvest during gastric cancer surgery.
- Enhanced lymph node sampling improves staging accuracy and potentially patient prognosis.
- Larger multicentric studies are needed to confirm long-term oncological benefits and validate the technique.
