Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2015; 7(5): 71-77
Published online May 27, 2015. doi: 10.4240/wjgs.v7.i5.71
Lymph node pick up by separate stations: Option or necessity?
Paolo Morgagni, Oriana Nanni, Elisa Carretta, Mattia Altini, Luca Saragoni, Fabio Falcini, Domenico Garcea
Paolo Morgagni, Domenico Garcea, Department of General Surgery, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy
Oriana Nanni, Elisa Carretta, Mattia Altini, Fabio Falcini, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
Luca Saragoni, Pathology Unit, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy
Author contributions: Morgagni P, Nanni O, Carretta E and Garcea D designed the study; Morgagni P, Nanni O, Carretta E, Altini M, Saragoni L and Falcini F were responsible for data collection; Morgagni P, Nanni O and Carretta E analyzed and interpreted the data; Nanni O and Carretta E performed the statistical analysis; Morgagni P, Nanni O, Carretta E and Saragoni L drafted the manuscript; all authors read and approved the final version of the paper.
Ethics approval: As anonymized administrative and clinical data were used for this study, it was exempt from formal ethics review.
Informed consent: As anonymized administrative and clinical data were used for this study, specific written consent was not required to use patient information stored in hospital databases.
Conflict-of-interest: There are no conflicts of interest to declare for this work.
Data sharing: Technical appendix, statistical code, and dataset are available from the corresponding author at p.morgagni@ausl.fo.it. Consent was not obtained but the presented data are anonymized and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paolo Morgagni, MD, Department of General Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, 47121 Forlì, Italy. p.morgagni@ausl.fo.it
Telephone: +39-543-735500 Fax: +39- 543-735522
Received: December 30, 2014
Peer-review started: January 2, 2015
First decision: January 20, 2015
Revised: March 2, 2015
Accepted: April 10, 2015
Article in press: April 14, 2015
Published online: May 27, 2015
Abstract

AIM: To evaluate whether lymph node pick up by separate stations could be an indicator of patients submitted to appropriate surgical treatment.

METHODS: One thousand two hundred and three consecutive gastric cancer patients submitted to radical resection in 7 general hospitals and for whom no information was available on the extension of lymphatic dissection were included in this retrospective study.

RESULTS: Patients were divided into 2 groups: group A, where the stomach specimen was directly formalin-fixed and sent to the pathologist, and group B, where lymph nodes were picked up after surgery and fixed for separate stations. Sixty-two point three percent of group A patients showed < 16 retrieved lymph nodes compared to 19.4% of group B (P < 0.0001). Group B (separate stations) patients had significantly higher survival rates than those in group A [46.1 mo (95%CI: 36.5-56.0) vs 27.7 mo (95%CI: 21.3-31.9); P = 0.0001], independently of T or N stage. In multivariate analysis, group A also showed a higher risk of death than group B (HR = 1.24; 95%CI: 1.05-1.46).

CONCLUSION: Separate lymphatic station dissection increases the number of retrieved nodes, leads to better tumor staging, and permits verification of the surgical dissection. The number of dissected stations could potentially be used as an index to evaluate the quality of treatment received.

Keywords: Gastric cancer, Lymph node, Separate station pick up, Lymphadenectomy

Core tip: Lymph node retrieval in the operating theater after surgical resection is a common practice in Eastern Asia. When applied in the west, the procedure permits a higher number of lymph nodes to be detected, thus improving tumor staging. In the present multicenter study in which the participating centers used different surgical procedures, patients who were submitted to accurate lymph node pick up showed better survival than those were not. Although we are aware that this procedure cannot improve survival, we believe that it can identify patients submitted to a more accurate treatment.