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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.
Cancers
|February 25, 2022
Summary
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.
