Natan Poluksht

The accuracy of sentinel node mapping according to T stage in patients with gastric cancer

BackgroundSentinel lymph node (SLN) mapping has been recently introduced to the field of gastric cancer. To the best of our knowledge, no study has dealt with the accuracy of SLN mapping according to the T stage of the primary tumor. The aim of the present study was to evaluate SLN status according to the T stage of the primary tumors.MethodsEighty patients with gastric cancer underwent SLN mapping with patent blue dye during gastric resection.ResultsForty-seven patients underwent distal subtotal gastrectomy; 17 patients, proximal gastrectomy; 14, total gastrectomy; and 2, gastric stump resection. SLNs were stained in 61/80 patients (76.3%). The number of stained SLNs varied from 1 to 16 (mean, 3.3). Patients undergoing proximal gastrectomy had a mean of 3 stained SLNs, whereas patients undergoing distal subtotal gastrectomy had a mean of 2.8 stained SLNs. In 55/61 patients (90.2%) with stained SLNs a positive correlation was found between the presence of metastases and stained or non-stained SLNs. Ten out of 11 patients (90.9%) with T1 tumors (mean, 3.27 SLNs per patient) and 15/17 patients with T2 tumors (88.2%; mean, 3 SLNs per patient) had stained SLNs as compared to only 33/48 (68.8%) of patients with T3 tumors (mean, 3.3 SLNs per patient). The positive predictive value of the SLN mapping was 100%, the negative predictive value was 76.9%, and sensitivity was 85.4%.ConclusionWhile in T1 and T2 tumors sentinel node mapping may be of assistance in the decision-making process regarding the extent of lymphadenectomy (sensitivity, 100%; negative predictive value, 90%-100%), SLN mapping in patients with T3 tumors will be misleading in a third of the patients and should not be attempted.

Reduced Postoperative Chronic Pain after Tension-Free Inguinal Hernia Repair Using Absorbable Sutures: A Single-Blind Randomized Clinical Trial

BACKGROUND Chronic pain after inguinal hernia repair occurs in 16% to 62% of patients. The underlying mechanism probably involves sensory nerve damage and abnormal healing that might be influenced by the materials chosen for the procedure. We hypothesize that nonabsorbable sutures used for mesh fixation to the surrounding tissues are associated with higher rates of chronic groin pain after surgery. STUDY DESIGN We conducted a single-blind randomized clinical trial to compare the effect of absorbable braided sutures (Vycril; Ethicon) and nonabsorbable monofilament sutures (Prolene; Ethicon) used in inguinal hernia repair on the rate of chronic pain. We assessed chronic pain using a 4-point verbal-rank scale during a 1-year postoperative follow-up period. RESULTS Study groups included 100 patients in each group. No age, sex, or hernia-side differences were observed between the study groups. Chronic pain rate after surgery was higher in the nonabsorbable monofilament suture group compared with the absorbable braided suture group (37 vs 26 patients; p = 0.056). Time to pain disappearance was longer in the nonabsorbable monofilament suture vs the absorbable braided suture group (115.3 days; 95% CI, 88-142.7 vs 77.4 days; 95% CI, 54.3-100.3; p = 0.038, respectively). A 1-year age increment reduces the risk for chronic pain occurrence by 2.2% (odds ratio = 0.978%; 95% CI, 0.961-0.995; p = 0.013). The use of nonabsorbable sutures increases the risk for chronic pain in 94.9% compared with absorbable sutures (odds ratio = 1.949; 95% CI, 1.039-3.658; p = 0.038). CONCLUSIONS Nonabsorbable suture use in inguinal hernia repair is associated with a higher rate of chronic pain and a longer time to pain disappearance as compared with absorbable sutures.

Incidence trends and mortality rates of gastric cancer in Israel

BackgroundGastric cancer is the fourth most common malignancy worldwide. The incidence trends and mortality rates of gastric cancer in Israel have not been studied in depth. The aim of our study was to try and investigate the aforementioned issues in Israel in different ethnic groups.MethodsThis retrospective study is based on the data of The Israel National Cancer Registry and The Central Bureau of Statistics. Published data from these two institutes were collected, summarized, and analyzed in this study.ResultsAround 650 new cases of gastric cancer are diagnosed yearly in Israel. While we noticed a decline during the period 1990–2007 in the incidence in the Jewish population (13.6–8.9 and 6.75–5.42 cases per 100,000 in Jewish men and women, respectively), an increase in the Arab population was noticed (7.7–10.2 and 3.7–4.2 cases per 100,000 in men and women, respectively). Age-adjusted mortality rates per 10,000 cases of gastric cancer decreased significantly, from 7.21 in 1990 to 5.46 in 2007, in the total population. The 5-year relative survival showed a slight increase for both men and women.ConclusionThere is a difference in the incidence and outcome of gastric cancer between the Jewish and Arab populations in Israel. The grim prognosis of gastric cancer patients in Israel is probably due to the advanced stage at which gastric cancer is diagnosed in Israel.

A comparative study on two different pathological methods to retrieve lymph nodes following gastrectomy

BACKGROUND The number of lymph nodes harvested during gastrectomy depends on the extension of lymphadenectomy and the method of lymph node retrieval. AIM The objective of this study was to evaluate two methods of lymph node retrieval in specimens of gastric cancer. METHODS The number of lymph nodes was compared using two different techniques. The technique used in the first group was manual dissection following formalin fixation, and the techniques used in the second group was fat-clearing by acetone. RESULTS Both groups were comparable for demographic and pathological variables. The average number of harvested nodes was 19.3 ± 10 for the manual group as compared to 26.1 ± 14 in the acetone group (P = 0.003). The differences in the average number of positive nodes did not reach statistical significance (4.6 compared to 6.9 nodes). CONCLUSION The acetone clearing technique enables the evaluation of a larger number of nodes. An increase, but statistically non significant, number of positive nodes was noted in the acetone group.

Tumor differentiation as related to sentinel lymph node status in gastric cancer

AIM To investigate the influence of tumor grade on sentinel lymph node (SLN) status in patients with gastric cancer (GC). METHODS We retrospectively studied 71 patients with GC who underwent SLN mapping during gastric surgery to evaluate the relationship between SLN status and tumor grade. RESULTS Poorly differentiated tumors were detected in 50/71 patients, while the other 21 patients had moderately differentiated tumors. SLNs were identified in 58/71 patients (82%). In 41 of the 58 patients that were found to have stained nodes (70.7%), the tumor was of the poorly differentiated type (group I), while in the remaining patients with stained nodes 17/58 (29.3%), the tumor was of the moderately differentiated type (group II). Positive SLNs were found in 22/41 patients in group I (53.7%) and in 7/17 patients in group II (41.2%) (P = 0.325). The rate of positivity for the SLNs in the two groups (53.7% vs 41.2%) was not statistically significant (P = 0.514). CONCLUSION Most of our patients were found to have poorly differentiated adenocarcinoma of the stomach and there was no correlation between tumor grade and SLN involvement.