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Risk Factors for Lymph Node Metastasis in Western Early Gastric Cancer After Optimal Surgical Treatment

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Lymph node metastasis (LNM) has a strong influence on the prognosis of patients with early gastric cancer (EGC). As minimally invasive treatments are considered appropriate for EGC, and lymphadenectomy may be restricted or even eliminated in some cases; it is imperative to identify the main risk factors for LNM to individualize the therapeutic approach. This study aims to evaluate the risk factors for LNM in EGC and to determine the adequacy of the endoscopic resection criteria in a western population.

Methods

EGC patients who underwent gastrectomy with lymphadenectomy were retrospectively analyzed utilizing a prospective database. The clinicopathological variables were assessed to determine which factors were associated to LNM.

Results

Among 474 enrolled patients, 105 had EGC (22.1%). LNM occurred in 13.3% of all EGC (10% T1a; 15.4% T1b). Tumor size, venous, lymphatic, and perineural invasions were confirmed as independent predictors of LNM by multivariate analysis. Expanded criteria were safely adopted only in selected cases, and 13.6% of patients who matched expanded indication had LNM.

Conclusions

Tumor size, venous, lymphatic, and perineural invasions were associated with LNM and should be considered as surrogate markers for surgical treatment of EGC. Expanded criteria for endoscopic resection can be safely adopted only in selected cases.

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Acknowledgements

The authors are grateful to Professor Mitchell C. Posner, Thomas D. Jones, Professor of Surgery, University of Chicago, for reading the manuscript and for his helpful suggestions.

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Authors and Affiliations

  1. Sao Paulo State Cancer Institute, Hospital das Clínicas, (ICESP-HCFMUSP), University of São Paulo School of Medicine, Avenida Dr Arnaldo, 251, Sao Paulo, 01246-000, Brazil

    Marina Alessandra Pereira, Marcus Fernando Kodama Pertille Ramos, André Roncon Dias, Sheila Friedrich Faraj, Osmar Kenji Yagi, Adriana Vaz Safatle-Ribeiro, Fauze Maluf-Filho, Bruno Zilberstein, Ivan Cecconello, Evandro Sobroza de Mello & Ulysses Ribeiro Jr

Authors
  1. Marina Alessandra Pereira
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  2. Marcus Fernando Kodama Pertille Ramos
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  3. André Roncon Dias
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  4. Sheila Friedrich Faraj
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  5. Osmar Kenji Yagi
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  6. Adriana Vaz Safatle-Ribeiro
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  7. Fauze Maluf-Filho
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  8. Bruno Zilberstein
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  9. Ivan Cecconello
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  10. Evandro Sobroza de Mello
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  11. Ulysses Ribeiro Jr
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Contributions

M.A. Pereira and M.F.K.P. Ramos proposed the topic, designed the study, analyzed the data, and wrote the manuscript. S.F. Faraj and E.S. de Mello carried out the microscopic review. A.R. Dias and O.Y. Kenji collaborated in data collection, enrolled patients, and interpretation of the data. U. Ribeiro Jr., B. Zilberstein, and I. Cecconello provided assistance in the study. A.V. Safatle-Ribeiro and F. Maluf-Filho analyzed the data and helped with the manuscript. U. Ribeiro Jr. performed a final critical revision. All authors read and approved the version to be published.

Corresponding author

Correspondence to Ulysses Ribeiro Jr.

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Ethical Standards

The study was approved by the hospital ethics committee (Sao Paulo State Cancer Institute, Hospital das Clínicas, (ICESP-HCFMUSP) Ethics Committee: 102/15), and all procedures followed were in accordance with the ethical standards. This article does not contain any prospective studies with human subjects performed by any of the authors.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Pereira, M.A., Ramos, M.F.K.P., Dias, A.R. et al. Risk Factors for Lymph Node Metastasis in Western Early Gastric Cancer After Optimal Surgical Treatment. J Gastrointest Surg 22, 23–31 (2018). https://doi.org/10.1007/s11605-017-3517-8

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  • DOI: https://doi.org/10.1007/s11605-017-3517-8

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