Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 28, 2009; 15(44): 5568-5572
Published online Nov 28, 2009. doi: 10.3748/wjg.15.5568
Routine modified D2 lymphadenectomy performance in pT1-T2N0 gastric cancer
John Griniatsos, Hara Gakiopoulou, Eugenia Yiannakopoulou, Nikoletta Dimitriou, Gerasimos Douridas, Afrodite Nonni, Theodoros Liakakos, Evangelos Felekouras
John Griniatsos, Eugenia Yiannakopoulou, Nikoletta Dimitriou, Gerasimos Douridas, Evangelos Felekouras, 1st Department of Surgery, University of Athens, Medical School, LAIKO Hospital, GR 115-27, Athens, Greece
Hara Gakiopoulou, Afrodite Nonni, Department of Pathology, University of Athens, Medical School, LAIKO Hospital, GR 115-27, Athens, Greece
Theodoros Liakakos, 3rd Department of Surgery, University of Athens, Medical School, ATTIKO Hospital, GR 115-27, Athens, Greece
Author contributions: Griniatsos J and Felekouras E designed the study, performed the operations and contributed to the preparation of the manuscript; Yiannakopoulou E and Dimitriou N wrote the manuscript; Gakiopoulou H and Nonni A performed the histopathology and immunohistochemistry; Douridas G performed the operations and reviewed the literature; Liakakos T checked the final version of the manuscript and made significant comments.
Correspondence to: John Griniatsos, MD, Assistant Professor, 1st Department of Surgery, University of Athens, Medical School, LAIKO Hospital, 17 Agiou Thoma street, GR 115-27, Athens, Greece. johngriniatsos@yahoo.com
Telephone: +30-210-7456855 Fax: +30-210-7771195
Received: August 11, 2009
Revised: September 7, 2009
Accepted: September 15, 2009
Published online: November 28, 2009
Abstract

AIM: To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemically detected skip micrometastases in level II lymph nodes.

METHODS: Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0. All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the level I lymph node stations (n = 4) were excluded from further analysis. The level II lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study.

RESULTS: Skip micrometastases in the level II lymph nodes were detected in 14% (4 out of 28) of the patients. The incidence was further increased to 17% (4 out of 24) in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No. 7 lymph node station. Thus, the disease was upstaged from stage IA to IB in one patient and from stage IB to II in three patients.

CONCLUSION: In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.

Keywords: Gastric cancer, D2 gastrectomy, D2 lymphadenectomy, Micrometastases, Skip metastases, Skip micrometastases