Abstract
Gastric cancer (GC) used to be one of the most common malignancies in the world and still is the second leading cause of malignancy-related death in the Far East. The most significant factors that were found to be associated with the clinical outcome in patients with non-metastatic (M0) gastric cancer is tumor's depth of invasion, the presence and the extend of lymphnode involvement, as well as the histological type according to Lauren (intestinal or diffuse). Although it is generally accepted that D2 gastrectomy is the procedure of choice to achieve adequate oncologic excision, there are quite many concerns for its use in patients with early gastric cancer (EGC), where No or N1 specimens are frequently reported. The last two decades, with the evolvement of cancer cell detection techniques, the attend of the medical community is focused on GC patients with solitary lymphnode metastasis (SLN) or micrometastasis (mM). There is a discussion whether SLN should be attributed as the “real” sentinel node (SN) and its projection on patients' survival. The aim of this study is to review the recent literature and attempt to clarify the clinical significance of SLN in gastric cancer.
Highlights
Surgery is the cornerstone of treatment in patients with gastric cancer (GC)
The identification of solitary lymphnode metastasis in GC seems to be correlated with tumor’s depth of invasion, diffuse type according to Lauren [5, 40] and is associated with increased risk for recurrence and possibly with worst survival rates
The level of infiltration of the gastric wall is an independent negative prognostic factor by itself, so it must be clarified whether the unfavorable outcomes are due to the tumor’s bad characteristics or due to the presence of SOLITARY LYMPHNODE METASTASIS (SLM)
Summary
Surgery is the cornerstone of treatment in patients with gastric cancer (GC). The Japanese colleagues have been pioneers in the study of gastric cancer, mapped and organized in basins the lymph node stations surrounding the stomach, and standardized the gastrectomy procedures according to the wideness of lymphatic resection to D1, D2, and D3. Many studies have shown that, even in early GC, there is high possibility of cancerous migration to the lymph nodes and it’s not uncommon that this migration occurred to just one node, the so called solitary lymphnode metastasis (SLN). The cancer spread in the lymph node does not exceed 2 mm, and called micrometastasis (mM) [2], while in other node specimens the malignant portion is fewer than 0.2 mm in diameter, considered to be isolated tumor calls (ITC’s)
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