Annals of Surgical Oncology

, Volume 21, Issue 2, pp 533–538 | Cite as

Oncologic Safety of Pylorus-preserving Gastrectomy in the Aspect of Micrometastasis in Lymph Nodes at Stations 5 and 6

  • Baek-hui Kim
  • Soon Won Hong
  • Jong Won Kim
  • Seung Ho Choi
  • Sun Och Yoon
Gastrointestinal Oncology



Pylorus-preserving gastrectomy (PPG) is a function-preserving gastrectomy for early gastric cancers (EGCs) that are preoperatively assessed as pN0 tumors and located in the middle portion of the stomach. In PPG, dissection of the lymph nodes at stations 5 and 6 is frequently incomplete, and this may be worrisome in terms of oncologic safety.


We examined lymph nodes collected from stations 5 and 6 from 196 patients who had undergone conventional distal gastrectomy (CDG) for EGC located in the middle portion of the stomach and from 24 patients who had undergone PPG.


The average number of lymph nodes collected at station 5 was significantly lower with PPG than with CDG (0.08 vs. 1.32, respectively; P = 0.008). However, such a difference was not noted for station 6 nodes. The rate of macrometastasis was very low in all station 5 nodes (1 of 220, 0.45 %) and station 6 nodes (1 of 220, 0.45 %). Immunohistochemical analysis of cytokeratin in 109 cases of the CDG group and 21 cases of the PPG group showed that micrometastasis of single isolated tumor cell type was observed in only one station 6 lymph node of a patient who was initially diagnosed with pN0 EGC. There were no cases of micrometastasis in station 5 nodes.


The possibility of micrometastasis to station 5 and/or 6 lymph nodes may be negligible for EGC located in the middle portion of the stomach, and PPG thus might be the oncologically safe procedure when considering micrometastasis in remaining nodes in vivo at stations 5 and 6.


Lymph Node Early Gastric Cancer Metastatic Lymph Node Middle Portion Isolate Tumor Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by a faculty research grant of Yonsei University College of Medicine for 2010 (6-2010-0109).


The authors declare no conflict of interest.


  1. 1.
    Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery. 1967;61:838–45.PubMedGoogle Scholar
  2. 2.
    Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.Google Scholar
  3. 3.
    Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer. 2007;10:167–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Park do J, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008;32:1029–36.PubMedCrossRefGoogle Scholar
  5. 5.
    Shibata C, Shiiba KI, Funayama Y, et al. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg. 2004;28:857–61.PubMedCrossRefGoogle Scholar
  6. 6.
    Kong SH, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK. The safety of the dissection of lymph node stations 5 and 6 in pylorus-preserving gastrectomy. Ann Surg Oncol. 2009;16:3252–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg. 2008;95:1131–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Ikeguchi M, Hatada T, Yamamoto M, et al. Evaluation of a pylorus-preserving gastrectomy for patients preoperatively diagnosed with early gastric cancer located in the middle third of the stomach. Surg Today. 2010;40:228–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Nitti D, Marchet A, Olivieri M, et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol. 2003;10:1077–85.PubMedCrossRefGoogle Scholar
  10. 10.
    Catalano V, Labianca R, Beretta GD, Gatta G, de Braud F, Van Cutsem E. Gastric cancer. Crit Rev Oncol Hematol. 2009;71:127–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Edge SB, American Joint Committee on Cancer. AJCC cancer staging manual. 7th edition. New York: Springer; 2010.Google Scholar
  12. 12.
    Aaltonen LA, Hamilton SR, World Health Organization, International Agency for Research on Cancer. Pathology and genetics of tumours of the digestive system. Oxford: IARC; 2000.Google Scholar
  13. 13.
    Arigami T, Uenosono Y, Yanagita S, et al. Clinical significance of lymph node micrometastasis in gastric cancer. Ann Surg Oncol. 2013;20:515–21.PubMedCrossRefGoogle Scholar
  14. 14.
    Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.Google Scholar
  15. 15.
    Rosai J, Ackerman LV. Rosai and Ackerman’s surgical pathology. 10th edition. New York: Mosby; 2011.Google Scholar
  16. 16.
    Cai J, Ikeguchi M, Maeta M, Kaibara N. Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer. Surgery. 2000;127:32–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Maehara Y, Oshiro T, Endo K, et al. Clinical significance of occult micrometastasis lymph nodes from patients with early gastric cancer who died of recurrence. Surgery. 1996;119:397–402.PubMedCrossRefGoogle Scholar
  18. 18.
    Morgagni P, Saragoni L, Folli S, et al. Lymph node micrometastases in patients with early gastric cancer: experience with 139 patients. Ann Surg Oncol. 2001;8:170–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Choi HJ, Kim YK, Kim YH, Kim SS, Hong SH. Occurrence and prognostic implications of micrometastases in lymph nodes from patients with submucosal gastric carcinoma. Ann Surg Oncol. 2002;9:13–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Morgagni P, Saragoni L, Scarpi E, et al. Lymph node micrometastases in early gastric cancer and their impact on prognosis. World J Surg. 2003;27:558–61.PubMedCrossRefGoogle Scholar
  21. 21.
    Miyake K, Seshimo A, Kameoka S. Assessment of lymph node micrometastasis in early gastric cancer in relation to sentinel nodes. Gastric Cancer. 2006;9:197–202.PubMedCrossRefGoogle Scholar
  22. 22.
    Cao L, Hu X, Zhang Y, Huang G. Adverse prognosis of clustered-cell versus single-cell micrometastases in pN0 early gastric cancer. J Surg Oncol. 2011;103:53–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Han KB, Jang YJ, Kim JH, et al. Clinical significance of the pattern of lymph node metastasis depending on the location of gastric cancer. J Gastric Cancer. 2011;11:86–93.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Pantel K, Brakenhoff RH, Brandt B. Detection, clinical relevance and specific biological properties of disseminating tumour cells. Nat Rev Cancer. 2008;8:329–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Weaver DL, Ashikaga T, Krag DN, et al. Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364:412–21.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Kunisaki C, Akiyama H, Nomura M, et al. Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol. 2006;13:363–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Nomura S, Kaminishi M. Surgical treatment of early gastric cancer. Dig Surg. 2007;24:96–100.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Baek-hui Kim
    • 1
  • Soon Won Hong
    • 2
  • Jong Won Kim
    • 3
  • Seung Ho Choi
    • 3
  • Sun Och Yoon
    • 2
  1. 1.Department of Pathology, Korea University Guro HospitalKorea University College of MedicineSeoulKorea
  2. 2.Department of Pathology, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
  3. 3.Department of Surgery, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea

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