| Budget Amount *help |
¥1,480,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥180,000)
Fiscal Year 2007: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000)
Fiscal Year 2006: ¥700,000 (Direct Cost: ¥700,000)
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| Research Abstract |
BACKGROUND Ultimate approach for total stomach preservation has became possible by our recent developed technique "laparoscopic lymph node dissection (LLD)" under sentinel node navigation, within has been performed for patients with early gastric cancer who have a potential of regional lymph node metastasis following endoscopic submucosal dissection (ESD). On the other hand, not only peri-nodal cancer deposits but also extra-nodal metastases were reportedly significant critical issue in any gastrointestinal malignancies. However, these particular issues especially in gastric cancer have not yet been well described. This study was designed to clarify the prognostic impact of these factors.
METHODS In this study, these extra-nodular lesions were named as cancer cell spread in the mesorectum (SM) and were sub-grouped by categorizing appearance on microscopic findings as follows; lymphatic involvement type (ly). Vessel involvement type (v), scattered type (sct), and extra-capsular invasion
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type (ext). The present study was composed of two analysis (STUDY1 and 2).
STUDY1 : Whole serial section of the mesogastrium ; This technique has not yet been described in the former literatures for detecting CNS. The mesogastrium was rolled-up. Then serial sections were performed. Prospectively, the mesogastriums in 34 patients with gastric cancer were examined by the technique with immunochemical stains such as anti-human cytokeratin antibody and a monoclonal antibody for D2-40, which was a specific marker of lymphatic vessels.
STUDY2 : Retrospective analysis of risk factor ; Retrospectively, former one hundred forty-four gastric cancer including early and advanced stage were evaluated. Since the previous specimen handling had been performed with lymph node extraction technique, this retrospective investigation could obtain solely in peri-nodal investigation.
RESULTS STUDY1: The CSM was detected in three (8.8%) of 34 patients. The CNS-positive patients were accompanied significantly by undifferentiated type, positive for lymph node metastasis, and lymphatic involvement. In three of these patients, one had the "sct" type; two had all types of CSM recognized in wide area of the mesogastrium. Two of these 3 patients had locally advanced type representing serosal or subserosal invasion. The CSM was found in 3 of 12 patients with advanced cancer, nor in 22 patients with early gastric cancer.
STUDY2: The CSM was detected in 23 (16%) of 144 specimens. The "ext" was detected in 15 specimens, "ly" in 14, "v" in 3, and "sct" in 2 patients and some of these findings were overlapped. The incidence of CSM was significantly prominent in the adverse events of advanced gastric cancer such as tumor size, the depth of invasion, advanced staging, positive for lymphatic vessel invasion, and distant metastasis. The CSM was found in 1.4% of early gastric cancer specimens with submucosal (sm) and 29% of advanced cancer specimens. In the cumulative 5-years follow-up after potential curative resection, the CSM-positive patients had significantly higher incidence of tumor recurrence than that of CSM-negative patients, so did overall survival (91% vs. 60%, p=0.01). Multivariate analysis revealed that CSM was an independent risk factor of adverse event(hazard ratio 3.1, p=0.04). Less
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