Ex vivo dissection increases lymph node yield in oesophagogastric cancer. Issue 1 (26th August 2013)

• Record Type: Journal Article
• Authors: Cichowitz, Adam; Burton, Paul; Brown, Wendy; Smith, Andrew; Shaw, Kalai; Slamowicz, Ron; Nottle, Peter D.
• Is Part Of: ANZ journal of surgery. Volume 85:Issue 1/2(2015)
• Page Start: 80
• Page End: 84
• Publication Date: 2013-08-26
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.12365
• Languages: English
• ISSNs: 1445-1433

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="ans12365-sec-0001" sec-type="section"> <title>Background</title> <p>Retrieval and analysis of an adequate number of lymph nodes is critical for accurate staging of oesophageal and gastric cancer. Higher total node counts reported by pathologists are associated with improved survival. A prospective study was undertaken to understand the factors contributing to variability in lymph node counts after oesophagogastric cancer resections and to determine whether a novel strategy of <italic>ex vivo</italic> dissection of resected specimens into nodal stations improves node counts reported by pathologists.</p> </sec> <sec id="ans12365-sec-0002" sec-type="section"> <title>Methods</title> <p>The study involved 88 patients with potentially curable oesophagogastric cancer undergoing radical resection. Lymph node counts were obtained from pathology reports and analysed in relation to multiple variables including the introduction of <italic>ex vivo</italic> dissection of nodal stations in theatre.</p> </sec> <sec id="ans12365-sec-0003" sec-type="section"> <title>Results</title> <p>Higher lymph node counts were obtained with <italic>ex vivo</italic> dissection of nodal stations (median 19 versus 8, <italic>P</italic> < 0.01). Node counts also varied significantly with the reporting pathologist (median range 4 to 48, <italic>P</italic> = 0.02) which was independent of the level of experience of the pathologist (<italic>P</italic> = 0.67). Node counts were not affected by patient age (<italic>P</italic> = 0.26), gender (<italic>P</italic> = 0.50), operative approach (<italic>P</italic> = 0.50) or neoadjuvant therapy (<italic>P</italic> = 0.83).</p> </sec> <sec id="ans12365-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Specimen handling is a significant factor in determining lymph node yield following radical oesophageal and gastric cancer resections. <italic>Ex vivo</italic> dissection of resected specimens into nodal stations improves node counts without alterations to surgical techniques. <italic>Ex vivo</italic> dissection should be considered routine.</p> </sec> </abstract>