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PubMed2000

[Ultrasonographic evaluation of metastatic cervical lymph nodes in head and neck cancers].

This study evaluates the use of ultrasonography (USG) to diagnose metastatic cervical lymph nodes. Three-hundred and one lymph nodes were removed from 58 patients with squamous cell carcinomas of the head and neck. None of the patients had received any preoperative treatments for cancer. The lymph nodes were then histopathologically examined: 139 metastatic lymph nodes and 162 non-metastatic nodes were found. USG was then used to evaluate the size, internal echo, and margin of each lymph node. Size was found to be the best criteria for distinguishing metastatic lymph nodes from non-metastatic lymph nodes in all cervical regions (78% accuracy). Superior internal jugular lymph nodes and submandibular lymph nodes larger than 7 mm and mid and inferior internal jugular lymph nodes larger than 6 mm were regarded as metastatic. Internal echoes were classified into five patterns: homogeneous hypoechoic, homogeneous hyperechoic, heterogeneous, eccentric hyperechoic, and centric hyperechoic. Homogeneous hyperechoic and heterogeneous patterns were characteristic of metastatic nodes, while eccentric hyperechoic patterns were characteristic of non-metastatic nodes. Homogeneous hypoechoic patterns were observed in both metastatic and non-metastatic nodes. Regular margins were found in 81% of the metastatic nodes. Of the 22 lymph nodes with irregular margins, however, 91% were metastatic. Evaluations using a combination of USG and clinical feature criteria were compared with evaluations using only thickness as a criterium. Although thickness is the single most important factor in diagnosing metastatic nodes, the combination of USG and clinical feature criteria improved the accuracy of diagnosis to 83%. Thus, diagnostic methods involving a combination of several criteria are more accurate than methods involving only a single criterium.

Carcinoma, Squamous Cell↗

PubMed2004

Two-step three-field lymph node dissection is beneficial for thoracic esophageal carcinoma.

Aggressive surgery including extensive lymph node dissection is considered necessary to improve the long-term survival of patients with esophageal carcinoma. While three-field lymph node dissection is widely performed for patients with thoracic esophageal carcinoma, cervical lymph node metastasis is uncommon. In order to reduce surgical stress, we have developed a two-step three-field lymph node dissection procedure for thoracic esophageal carcinoma. In the first-step operation, total thoracic esophagectomy through a right thoracotomy is performed. Mediastinal and abdominal lymph node dissection is performed synchronously. When recurrent nerve lymph node metastasis is pathologically positive, cervical lymph node dissection is performed about 3 weeks after the first operation (second step). Of 343 patients with carcinoma of the esophagus surgically treated in our department between 1990 and 2001, 146 underwent the operation described above. Three-field dissection was performed in 68 patients (group A), while two-field dissection was performed in 78 patients (group B). In the 68 group A patients, cervical lymph node metastasis was positive in 15 patients (22%). There was no marked difference in the onset of major complications between the two groups. The 5-year survival rate was 58% for group A and 61% for group B, not a statistically significant difference. In 78 of the 146 patients, it was possible to avoid cervical lymph node dissection without negatively affecting therapeutic outcomes. Two-step three-field lymph node dissection can reduce surgical stress of patients with good clinical outcome.

Aged↗

PubMed2003

Tuberculosis of axillary lymph nodes with primary breast cancer.

A rare case of tuberculosis of axillary lymph nodes occurring with primary breast cancer is presented. A 78-year-old woman with no history of pulmonary tuberculosis was admitted to our hospital to undergo examination for a lump in her right breast. The tumor was in the upper outer quadrant of the right breast. On palpation, the tumor was 1.2 cm in diameter and axillary lymph node swelling was noted. Mammography disclosed a spiculated mass and swelling and calcification of the axillary lymph nodes. Sonography showed an irregular hypoechoic mass in the right breast and lymph node swelling in the right axilla, indicating breast cancer with axillary lymph nodes metastases. Chest X-ray showed clustered calcifications in the right axilla and a granular shadow in the right upper lobe. Breast conserving therapy was carried out. Invasive papillotubular carcinoma of the right breast and granulomas with calcification of lymph nodes, compatible with tuberculosis, was diagnosed. Tubercle bacillis were detected by culture of lymph nodes. This case suggests that X-ray is useful for diagnosing lymph node tuberculosis. Lymph node tuberculosis should be suspected when lymph node swelling is noted and X-ray shows clustered calcifications in axillary lymph nodes.

Aged↗

PubMed2005

Sentinel lymph node biopsy in the management of ductal carcinoma in situ.

Sentinel lymph node biopsy (SLNB) has been adopted by some physicians in the evaluation of ductal carcinoma in situ (DCIS). In a review of the current literature, we found no convincing data that SLNB is warranted as standard of care in newly diagnosed DCIS. Although lymph node invasion is present in 2% of women with traditional axillary lymph node dissection (ALND), as a result of the excellent prognosis of DCIS, it is not recommended. However, the detailed evaluation of the lymph node(s) with SLNB raises the issue that perhaps patients at risk for recurrence can be identified early and be treated aggressively without the morbidity associated with ALND. Limited data suggest that, with the use of more sensitive methods for detection of cytokeratin-positive cells, the prevalence of positive lymph nodes in pure DCIS is approximately 2%-13%. In high-risk DCIS or DCIS with microinvasion, the prevalence is 8%-20%. Several limited retrospective studies with long-term follow-up have not demonstrated an adverse relapse-free or overall survival effect for women with immunohistochemically (IHC) positive cells in the lymph nodes compared with those with negative IHC results in the lymph nodes. Sentinel lymph node biopsy in DCIS is associated with known risks, and health care benefits, if any, have not been demonstrated. Sentinel lymph node biopsy is not recommended in patients with DCIS.

Axilla↗

PubMed2006

Differential expression of a gene signature for scavenger/lectin receptors by endothelial cells and macrophages in human lymph node sinuses, the primary sites of regional metastasis.

Sentinel lymph node biopsy for several cancers has shown that metastatic tumour cells are preferentially arrested in the lymph node sinuses. To study the molecular components of this sinusoidal trap, gene profiling of lymph node (sinuses) versus tonsil (no sinuses) was performed. Among other groups of molecules, an intriguing gene signature of scavenger and lectin-like receptors was identified. Nine of the 13 genes were preferentially expressed in sinusoidal cells by immunohistochemistry. Using stabilin-2 and monoclonal antibody 3A5 as exclusive endothelial cell (EC) and macrophage (Mvarphi) markers, respectively, lymph node sinusoidal ECs (stabilin-2+, LYVE-1+, DC-SIGNR+, MARCO+, stabilin-1+, MMR+) and sinusoidal Mvarphi (MMR+, DC-SIGN+, sialoadhesin+, CD163+, stabilin-1+ ) showed distinct, but overlapping expression patterns of the signature molecules by double labelling immunofluorescence. The number of stabilin-1+ sinusoidal Mvarphi, however, varied considerably between samples, indicating turnover/differentiation dynamics in this sinusoidal cell population. In the hepatic sinuses, LYVE-1 and CD36 were strongly up-regulated on both sinusoidal ECs and Mvarphi, while DC-SIGNR and DC-SIGN were strongly down-regulated; in contrast to lymph node sinusoidal ECs, MARCO was confined to Mvarphi (Kupffer cells) in the liver sinuses. As Mvarphi are not present in the wall and lumen of splenic sinuses, splenic sinuses expressed a considerably reduced repertoire of scavenger/lectin receptors lacking sialoadhesin, CD36, CD163, and MARCO; in addition, DC-SIGNR was absent from splenic sinusoidal ECs, while DC-SIGN and thrombomodulin were strongly expressed. Interestingly, most of the signature molecules are known to mediate tumour cell adhesion in addition to their functions as scavenger or pattern recognition receptors. This study establishes a gene and tissue database platform to test the hypothesis that additive expression of the lymph node sinus signature genes in sinusoidal ECs and Mvarphi may contribute to selective tumour cell metastasis in lymph nodes and liver including organ-specific mechanisms, such as intraluminal retention or transmigration, while sparing the spleen.

Biomarkers↗

PubMed2004

Efficacy of manual dissection of lymph nodes in colon cancer resections.

The adequacy of lymph node dissection of colonic resection specimens influences the clinical and pathologic staging, leading to important postsurgical treatment decisions. Although manual lymph node dissection is the current standard at most institutions, recent statistical studies indicate that all lymph nodes, including those measuring 1-2 mm, should be recovered to be assured of lymph node negative status. Thus, we tested the efficacy of gross dissection by submitting the entire residual mesenteric fat. We analyzed 15 randomly chosen colonic resections (2 pT1, 1 pT2, 11 pT3, 1 pT4). After standard gross dissection of lymph nodes and submission of colonic material for diagnosis, the entire remaining mesenteric material was dehydrated over several days by serial washing in alcohol and acetone. All of the mesenteric tissue was submitted for histology. The average number of nodes found by original gross inspection was 20.8, while the average number of additional nodes found after clearing was 68.6. In all, 83% of the additional nodes were 2.0 mm or less in size. There were seven pN0 cases; one was upstaged by additional findings that may have been artifactual. There were four pN1 cases; three were upstaged to pN2 after submission of the mesenteric material. All four pN2 tumors had additional metastases identified. In all, 75% of all positive nodes were under 2.0 mm in size. In this limited sample, standard gross dissection proved sufficient for most pN0 tumors to remain node negative. However, our findings within the pN1 group show that examination of all of the mesenteric material may be necessary to be assured of correct pN status.

Adenocarcinoma↗

PubMed2006

Pattern of lymph node metastases in patients with squamous cell carcinoma of the thoracic esophagus who underwent three-field lymphadenectomy.

BACKGROUND/AIMS: Lymph nodes in patients with squamous cell carcinoma of the thoracic esophagus might be involved with metastases at cervical, mediastinal, and abdominal sites. The range of lymph node dissection is still controversial. The pattern of lymph node metastasis and factors that are correlated with lymph node metastasis affect the surgical procedure of lymph node dissection. The purpose of the present study was to explore the pattern of lymph node metastasis and factors that are correlated with lymph node metastasis in patients with esophageal cancer who underwent three-field lymphadenectomy. METHODS: Lymph node metastases in 230 patients who underwent radical esophagectomy with three-field lymphadenectomy were analyzed. The metastatic sites of lymph nodes were correlated with tumor location by chi-square test. Logistic regression was used to analyze clinicopathological factors related to lymph node metastasis. RESULTS: Lymph node metastases were found in 133 of the 230 patients (57.8%). The average number of resected lymph nodes was 25.3 +/- 11.4 (range 11-71). The proportions of lymph node metastases were 41.6, 19.44, and 8.3% in neck, thoracic mediastinum, and abdominal cavity, respectively, for patients with upper thoracic esophageal carcinomas, 33.3, 34.7, and 14%, respectively, in those with middle thoracic esophageal carcinomas, and 36.4, 34.1, and 43.2%, respectively, for patients with lower thoracic esophageal carcinomas. We did not observe any significant difference in lymph node metastatic rates among upper, middle, and lower thoracic carcinomas for cervical or thoracic nodes. The difference in lymph node metastatic rates for nodes in the abdominal cavity was significant among upper, middle, and lower thoracic carcinomas. The lower thoracic esophageal cancers were more likely to metastasize to the abdominal cavity than tumors at other thoracic sites. A logistic regression model showed that depth of tumor invasion and lymphatic vessel invasion were factors influencing lymph node metastases. CONCLUSIONS: Based on our data, cervical and mediastinal node dissection should be performed independent of the tumor location. Abdominal node dissection should be conducted more vigorously for lower thoracic esophageal cancers than for cancers at other locations. Patients with deeper tumor invasion or lymphatic vessel invasion were more likely to develop lymph node metastases.

Carcinoma, Squamous Cell↗

PubMed1993

Role of surgery and chemotherapy for peripheral lymph node tuberculosis.

A total of 105 patients with peripheral lymph node tuberculosis were treated by either surgical excision and chemotherapy or chemotherapy alone. The cervical nodes were affected in 98 patients, axillary nodes in four and inguinal nodes in three. Biopsy of the lymph nodes confirmed the diagnosis in all cases. Thirty-five patients who had sinus, ulcer or abscess underwent excision of the lymph nodes with drainage of the abscess, or resection of the sinus or ulcer. The remaining 70 patients received only chemotherapy. Chemotherapy in all patients consisted of isoniazid and ethambutol for 18 months. Of the 35 patients treated with surgery and chemotherapy, two had gaping wounds, one infection and one cellulitis of the face and neck. After 3 months, one patient had recurrence of the lymph node mass and one recurrence of a sinus; these were excised. Of the 70 patients treated only with chemotherapy, 13 were lost to follow-up. Four had non-healing wounds at the biopsy site, six wound infection and two sinus formation. Five of these patients had persistent lymph node masses, which were excised after 3 months. The remaining 52 patients had no recurrence.

Adolescent↗

PubMed2002

Preliminary experiences with sentinel lymph node detection in cases of vulvar malignancy.

Lymph node status is the most important prognostic factor in vulvar malignancy. The aim of this pilot study was to explore the clinical significance of radionuclide lymphoscintigraphy in the management of vulvar neoplasms. Eight patients with squamous cell carcinoma and two patients with malignant melanoma of the vulva were studied with 100 MBq technetium-99m nanocolloid (Sentiscint, OSSKI, Budapest) 1 day before surgery. The location of the sentinel lymph node was checked by a single-head gamma camera-computer system (MB 9200, Mediso, Budapest). Vulvectomy with bilateral inguinofemoral lymphadenectomy was performed in each case. At lymphadenectomy, the sentinel lymph node was separately removed and histologically studied. Three of the ten patients had positive sentinel lymph nodes (micrometastasis). Five months later one of them had local recurrence of the vulvar cancer, and another had inguinal recurrence of the tumour 6 months postoperatively; the third patient was operated on only recently. Our preliminary results are impressive and suggest that lymphoscintigraphy is an easy and reliable method for detection of the sentinel lymph node in vulvar malignancy.

Aged↗

PubMed2006

Validation of a breast cancer nomogram for predicting nonsentinel lymph node metastases after a positive sentinel node biopsy.

BACKGROUND: Although completion lymph node dissection (CLND) is the standard of care for breast cancer patients with sentinel lymph node (SLN) metastases, the SLN is the only node with tumor in 40% to 60% of cases. To assist with decision-making regarding CLND, investigators at Memorial Sloan-Kettering Cancer Center devised and validated a nomogram for predicting the likelihood of non-SLN metastases. To assess the generalizable use of this nomogram, validation analysis was performed by using an external database. METHODS: Eight clinicopathologic variables for 200 consecutive breast cancer patients at the University of Texas M. D. Anderson Cancer Center with SLN metastases and CLND were entered into the nomogram. The accuracy of the nomogram to predict non-SLN metastases was assessed by the receiver operating characteristic (ROC) curve and linear regression analysis. The accuracy of the nomogram with touch-imprint cytology (TIC) as a substitute variable for frozen section was also evaluated. RESULTS: The linear correlation coefficient of the nomogram-predicted probabilities correlated with the observed incidence of non-SLN metastases for all patients (.97). The accuracy of the nomogram as measured by the area under the ROC curve was .71. When applied solely to patients who had TIC assessment of the SLN, the area under the ROC curve was .74. CONCLUSIONS: This study validated the Memorial Sloan-Kettering Cancer Center breast cancer nomogram by using an external database. TIC seems to be an acceptable substitute for frozen section as a nomogram variable. The nomogram may help predict an individual's risk of non-SLN metastases and assist in patient decision making regarding the benefit of CLND.

Algorithms↗

PubMed1997

A pilot study utilizing intraoperative lymphoscintigraphy for identification of the sentinel lymph nodes in vulvar cancer.

OBJECTIVE: To identify sentinel lymph nodes using intraoperative lymphoscintigraphy. METHODS: Technetium-99-labeled sulfur colloid was injected at the site of primary vulvar carcinoma. An intraoperative gamma counter was used to identify one or more sentinel lymph nodes. RESULTS: Ten patients underwent bilateral inguinal and femoral lymphadenectomy. The clinical stages are as follows: T1 in 6, T2 in 2, and T3 in 2. A total of four groins (3 patients) were positive for metastases. In one patient only the sentinel node was positive for disease. In a second patient, two unilateral nodes were positive for disease and both were identified with the gamma counter as sentinel nodes. In the third patient, a single sentinel node was positive for malignancy in each groin. Multiple nonsentinel lymph nodes were positive in each groin in this patient. In no case was the sentinel node negative when other nonsentinel nodes were positive. CONCLUSION: Intraoperative lymphoscintigraphy quantitatively identifies one or more sentinel lymph nodes. Since sentinel lymph nodes can be localized transcutaneously, this technique may be useful for selective lymphadenectomy. Larger patient accrual is necessary to verify this technique.

Female↗

PubMed1994

A scanning electron microscope study of the human cervical lymph node.

Arterial casts of human cervical lymph nodes were studied using scanning electron microscopy. Human cervical lymph nodes appear to be much more complex and dense than their animal counterparts. Human lymph nodes have a separate medulla arising from the hilar artery complex and cortical structure derived from capillaries. Also present is a previously unknown rosette formation of blood vessels. The possible implications of these findings for inflammatory and neoplastic diseases are discussed.

Arteries↗

PubMed2005

Quantitative analysis of lymphangiogenic markers for predicting metastasis of human gastric carcinoma to lymph nodes.

The spread of tumor cells to regional lymph nodes is an early event of gastric cancer metastasis. In our study, we assessed the expression of lymphangiogenic factors and lymphatic endothelial markers in gastric carcinoma tissues and compared expression levels with the status of lymph node metastasis. We also examined the correlation between lymphatic vessel density (LVD) in primary tumors and lymph node metastasis. Paired biopsy samples (tumor and corresponding normal mucosa) of gastric tissue were obtained from 39 patients with gastric carcinoma. The expression of VEGF-C, VEGF-D, VEGFR-3 and podoplanin mRNAs was assessed by real-time quantitative PCR. The expression of VEGF-C (but not of VEGF-D) was significantly greater in patients with lymph node metastasis than in those without metastasis. The expression of lymphatic endothelial markers VEGFR-3 and podoplanin was also significantly greater in the node-positive group. LVD, as assessed by immunohistochemistry for podoplanin, was correlated with lymph node metastasis. These results indicate that quantitative analysis of lymphangiogenic markers in gastric biopsy specimens may be useful in predicting metastasis of gastric cancer to regional lymph nodes.

Biomarkers, Tumor↗

PubMed2025

Altered immune signatures in breast cancer lymph nodes with metastases revealed by spatial proteome analyses.

BACKGROUND: Metastasis to lymph nodes is strongly associated with reduced survival in breast cancer patients. To increase the understanding on how lymph node metastasis impairs the local immune response in affected lymph nodes, we here studied spatial proteomic changes of critical lymph node immune populations in uninvolved lymph nodes (UnLN) and paired lymph nodes with metastases (LNM) from five breast cancer patients. METHODS: The proteome was analyzed for cortical lymphocyte compartments, subcapsular sinus (SCS) and medullary sinus (MS) CD169+ macrophages, using the Digital Spatial Profiling (DSP) platform from NanoString. RESULTS: Our results identified a stable proteome of SCS CD169+ macrophages in LNM, with the exception for downregulation of the anti-apoptotic protein Bcl-xL and FAPα, but a clear reduction in numbers of SCS CD169+ macrophages in LNM. In contrast, the proteome of MS CD169+ macrophages, B-cell compartments and interfollicular T-cells showed altered immune signatures in LNM, indicating that the decline in SCS CD169+ macrophages coincide with a malfunction in the local, anti-tumor immune responses. CONCLUSIONS: The findings from our study support the notion that metastasis to lymph nodes in breast cancer patients modifies local immune responses. These changes may contribute to explain unsuccessful therapeutic responses, and thereby worsened prognosis, for breast cancer patients with LNM.

Breast Neoplasms↗

PubMed1995

Scanning electron microscopic studies of reticular framework in the rat mesenteric lymph node.

BACKGROUND: The reticular framework in the lymph node has in the past been studied mainly by light microscopy of silver-impregnated specimens. The aim of the present study is to understand three-dimensionally the ultrastructure and organization of the reticular framework better than before. METHODS: The mesenteric lymph nodes of the rat were prepared either an alkali-water maceration method or a conventional method and were observed in a scanning electron microscope (SEM). RESULTS: The SEM study of alkali-water macerated tissues visualized directly the reticular fiber network in the lymph node. The reticular fibers consisted of thin bundles of collagen fibrils. They were continuous with the collagen fibrillar sheaths of blood vessels and lymphatic sinuses as well as with the fibrous capusule, thus acting as a skeleton of the lymph node. The arrangement of the reticulum was variable, depending on individual compartments. The SEM study of conventionally treated tissues, on the other hand, clarified the shape of reticular cells and their relationship with the reticular fibers. The sinus reticular cells connected with the sinus lining cells but separated from the parenchymal reticular cells, indicating that the former two originate from lymphatic endothelial cells. The parenchymal reticular cells varied in shape depending on their locations but essentially shared features with fibroblasts. CONCLUSIONS: The arrangements of the reticular fibers in the parenchyma were closely related to the associated reticular cells, showing the possibility that the reticular cells maintain the shape of the reticular framework suitable for each compartment of the lymph node.

Animals↗

PubMed2003

Complications associated with sentinel lymph node biopsy for melanoma.

BACKGROUND: Sentinel lymph node (SLN) biopsy has become widely accepted as a method of staging the regional lymph nodes for patients with melanoma. Although it is often stated that SLN biopsy is a minimally invasive procedure associated with few complications, a paucity of data exists to specifically determine the morbidity associated with this procedure. This analysis was performed to evaluate the morbidity associated with SLN biopsy compared with completion lymph node dissection (CLND). METHODS: Patients were enrolled in the Sunbelt Melanoma Trial, a prospective multi-institutional study of SLN biopsy for melanoma. Patients underwent SLN biopsy and were prospectively followed up for the development of complications associated with this technique. Patients who had evidence of nodal metastasis in the SLN underwent CLND. Complications associated with SLN biopsy alone were compared with those associated with SLN biopsy plus CLND. RESULTS: A total of 2120 patients were evaluated, with a median follow-up of 16 months. Overall, 96 (4.6%) of 2120 patients developed major or minor complications associated with SLN biopsy, whereas 103 (23.2%) of 444 patients experienced complications associated with SLN biopsy plus CLND. There were no deaths associated with either procedure. CONCLUSIONS: SLN biopsy alone is associated with significantly less morbidity compared with SLN biopsy plus CLND.

Adult↗

PubMed2000

The clinical spectrum of the sarcoid peripheral lymph node.

BACKGROUND: The finding of sarcoid-type granulomas in a peripheral lymph node (PLN) without clinical evidence of changes suggestive of sarcoidosis elsewhere poses a diagnostic problem. The long term follow-up of these patients has never been described in adults. AIMS OF THE WORK: 1. To describe in the above population whether and when a definite diagnosis of sarcoidosis was eventually made, and the time required to make the diagnosis. 2. To study the percentage of peripheral lymph node presentation in sarcoidosis. PATIENTS: A peripheral lymph node presentation, with lymph node biopsy demonstrating sarcoid granulomas, was seen in 127 patients over the last 20 years. Detailed investigation permitted the early diagnosis of sarcoidosis in 76, and of sarcoid reaction in 8 patients. The other 43-patients with granulomatous lymph node and no clinical evidence of changes outside the lymphatic system at the onset are the subject of the present study. METHODS: Periodic examination at our Sarcoid Clinic every 2 to 4 months, in a long term median follow-up of 36 months (range 1 to 203) and workup according to clinical need, including chest X ray and Computed Axial Tomography (CAT), pulmonary function tests, total body 67Ga scan, Broncho Alveolar Lavage (BAL) studies, blood cell counts, 24 h calciuria and urine analysis, serological tests for liver function, calcaemia, Angiotensin Converting Enzyme (ACE). RESULTS: The diagnosis of sarcoidosis (chronic in all) could be made in 33 patients (25 pulmonary, 8 extrapulmonary), after a median time from presentation of 5 years (range 3-288 months). In the other 10, in spite of a median duration of the illness of 62 months (range 20-487), our diagnosis has been idiopathic granulomatous disease of peripheral lymph nodes. Thus, we observed 109 patients in 20 years presenting with lymph nodes that were surgically removed and provided the diagnosis of sarcoidosis sooner (76 patients) or later (33 patients). CONCLUSIONS: 1. In patients presenting only sarcoid granulomas in peripheral lymph nodes, sarcoidosis may be diagnosed months or years later, but a subpopulation of them still exists where granulomatous lesions remain unexplained. 2. In our series of patients, peripheral lymph node presentation occurred in 11.7% of cases of sarcoidosis.

Adult↗

PubMed1990

[Surgical treatment of stomach cancer with extended removal of lymph nodes].

The authors evaluate the results of extensive lymph node dissection for gastric cancer at 50 patients. It has been found that the lymph node dissection did not increase the risk of operation. The mortality rate was 2%. The average number of removed and histologically examined lymph nodes was 26. The extensive lymph node dissection and the accurate histology provided opportunity for precise staging. Their first evaluation of survival showed an encouraging improvement of prognosis regard to that of patients survival treated by traditional surgical method. Besides it they reviewed the classification of Japanese Research Society for Gastric Cancer for the lymph drainage of the stomach and the surgical technique of the lymph node dissection.

Gastrectomy↗