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A methylene blue-assisted technique for harvesting lymph nodes after radical surgery for gastric cancer: a prospective, randomized, controlled study.

Aoyama T, Fujikawa H, Cho H, Ogata T, Shirai J, Hayashi T, Rino Y, Masuda M, Oba MS, Morita S, Yoshikawa T - Am. J. Surg. Pathol. (2015)

Bottom Line: The ratio of the number of the harvested LNs per time was 1.12±0.46 LNs/min in the conventional arm and 1.49±0.59 LNs/min in the methylene blue arm (P=0.010).In the subgroup analyses, the quality and efficacy were both superior for the methylene blue dye method compared with the conventional method.The methylene blue technique is recommended for harvesting LNs during gastric cancer surgery on the basis of both the quality and efficacy.

View Article: PubMed Central - PubMed

Affiliation: *Department of Gastrointestinal Surgery, Kanagawa Cancer Center †Department of Surgery, Yokohama City University ‡Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Japan.

ABSTRACT
Harvesting lymph nodes (LNs) after gastrectomy is essential for accurate staging. This trial evaluated the efficiency and quality of a conventional method and a methylene blue-assisted method in a randomized manner. The key eligibility criteria were as follows: (i) histologically proven adenocarcinoma of the stomach; (ii) clinical stage I-III; (iii) R0 resection planned by gastrectomy with D1+ or D2 lymphadenectomy. The primary endpoint was the ratio of the pathologic number of harvested LNs per time (minutes) as an efficacy measure. The secondary endpoint was the number of harvested LNs, as a quality measure. Between August 2012 and December 2012, 60 patients were assigned to undergo treatment using the conventional method (n=29) and the methylene blue dye method (n=31). The baseline demographics were mostly well balanced between the 2 groups. The number of harvested LNs (mean±SD) was 33.6±11.9 in the conventional arm and 43.4±13.9 in the methylene blue arm (P=0.005). The ratio of the number of the harvested LNs per time was 1.12±0.46 LNs/min in the conventional arm and 1.49±0.59 LNs/min in the methylene blue arm (P=0.010). In the subgroup analyses, the quality and efficacy were both superior for the methylene blue dye method compared with the conventional method. The methylene blue technique is recommended for harvesting LNs during gastric cancer surgery on the basis of both the quality and efficacy.

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The results of the subgroup analysis of the differences in the mean number of harvested LNs for the eligible population.
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Figure 5: The results of the subgroup analysis of the differences in the mean number of harvested LNs for the eligible population.

Mentions: The subgroup analyses were performed according to the type of gastrectomy, the extent of LN dissection, sex, and BMI. The difference in the mean between arms and its 95% confidence interval in the number of the harvested LNs and the ratios of the number of the harvested LNs per time were plotted in Figures 5 and 6, respectively. The P values for the interaction were not statistically significant in any of the categories, although the BMI tended to have interaction with the number of LNs harvested (P=0.136). The methylene blue arm showed better results than the conventional arm in terms of both the number and the ratio in all subgroups of each category.


A methylene blue-assisted technique for harvesting lymph nodes after radical surgery for gastric cancer: a prospective, randomized, controlled study.

Aoyama T, Fujikawa H, Cho H, Ogata T, Shirai J, Hayashi T, Rino Y, Masuda M, Oba MS, Morita S, Yoshikawa T - Am. J. Surg. Pathol. (2015)

The results of the subgroup analysis of the differences in the mean number of harvested LNs for the eligible population.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4306537&req=5

Figure 5: The results of the subgroup analysis of the differences in the mean number of harvested LNs for the eligible population.
Mentions: The subgroup analyses were performed according to the type of gastrectomy, the extent of LN dissection, sex, and BMI. The difference in the mean between arms and its 95% confidence interval in the number of the harvested LNs and the ratios of the number of the harvested LNs per time were plotted in Figures 5 and 6, respectively. The P values for the interaction were not statistically significant in any of the categories, although the BMI tended to have interaction with the number of LNs harvested (P=0.136). The methylene blue arm showed better results than the conventional arm in terms of both the number and the ratio in all subgroups of each category.

Bottom Line: The ratio of the number of the harvested LNs per time was 1.12±0.46 LNs/min in the conventional arm and 1.49±0.59 LNs/min in the methylene blue arm (P=0.010).In the subgroup analyses, the quality and efficacy were both superior for the methylene blue dye method compared with the conventional method.The methylene blue technique is recommended for harvesting LNs during gastric cancer surgery on the basis of both the quality and efficacy.

View Article: PubMed Central - PubMed

Affiliation: *Department of Gastrointestinal Surgery, Kanagawa Cancer Center †Department of Surgery, Yokohama City University ‡Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Japan.

ABSTRACT
Harvesting lymph nodes (LNs) after gastrectomy is essential for accurate staging. This trial evaluated the efficiency and quality of a conventional method and a methylene blue-assisted method in a randomized manner. The key eligibility criteria were as follows: (i) histologically proven adenocarcinoma of the stomach; (ii) clinical stage I-III; (iii) R0 resection planned by gastrectomy with D1+ or D2 lymphadenectomy. The primary endpoint was the ratio of the pathologic number of harvested LNs per time (minutes) as an efficacy measure. The secondary endpoint was the number of harvested LNs, as a quality measure. Between August 2012 and December 2012, 60 patients were assigned to undergo treatment using the conventional method (n=29) and the methylene blue dye method (n=31). The baseline demographics were mostly well balanced between the 2 groups. The number of harvested LNs (mean±SD) was 33.6±11.9 in the conventional arm and 43.4±13.9 in the methylene blue arm (P=0.005). The ratio of the number of the harvested LNs per time was 1.12±0.46 LNs/min in the conventional arm and 1.49±0.59 LNs/min in the methylene blue arm (P=0.010). In the subgroup analyses, the quality and efficacy were both superior for the methylene blue dye method compared with the conventional method. The methylene blue technique is recommended for harvesting LNs during gastric cancer surgery on the basis of both the quality and efficacy.

Show MeSH
Related in: MedlinePlus