nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow
Abstract Background The correlation between tumor location and lymphatic flow distribution in gastric cancer has been previously reported, and PTD (Proximal – Transitional – Distal) classification was proposed. Our group updated and developed the nPTD classification. Method We retrospectively studie...
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | BMC Cancer |
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| Online Access: | https://doi.org/10.1186/s12885-021-08936-9 |
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| author | Shinichi Kinami Naohiko Nakamura Tomoharu Miyashita Hidekazu Kitakata Sachio Fushida Takashi Fujimura Tohru Itoh Hiroyuki Takamura |
| author_facet | Shinichi Kinami Naohiko Nakamura Tomoharu Miyashita Hidekazu Kitakata Sachio Fushida Takashi Fujimura Tohru Itoh Hiroyuki Takamura |
| author_sort | Shinichi Kinami |
| collection | DOAJ |
| description | Abstract Background The correlation between tumor location and lymphatic flow distribution in gastric cancer has been previously reported, and PTD (Proximal – Transitional – Distal) classification was proposed. Our group updated and developed the nPTD classification. Method We retrospectively studied gastric cancer patients who underwent the dye method sentinel node biopsy from 1993 to 2020. The inclusion criteria were a single lesion type 0 cancer of ≤5 cm in the long axis, clinically node-negative, and invasion within the proper muscle layer pathologically. In this study, the distribution of dyed lymphatic flow was evaluated for each occupied area of the tumor. Results We included 416 patients in this study. The tumors located in the watershed of the right and left gastroepiploic arteries near greater curvature had extensive lymphatic flow; therefore, a newly circular region with a diameter of 5 cm is set on the watershed of the greater curvature between P and T zone as the ‘n’ zone. In addition, for cancers located in the lesser P curvature, lymphatic flow to the greater curvature was not observed. Therefore, the P zone was divided into two: the lesser curvature side (PL) and the greater curvature side (PG). Conclusions The advantage of the nPTD classification is that it provides not only proper nodal dissection but also adequate function-preserving gastrectomy. If the tumor is localized within the PL, the proximal gastrectomy resection area can be further reduced. In contrast, for cancers located in the ‘n’ zone, near-total gastrectomy is required because of the extensive lymphatic flow. |
| first_indexed | 2024-12-18T04:26:50Z |
| format | Article |
| id | doaj.art-2d2e637ae4f24f4896f2e8dcc76453f8 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-18T04:26:50Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-2d2e637ae4f24f4896f2e8dcc76453f82022-12-21T21:21:05ZengBMCBMC Cancer1471-24072021-11-0121111010.1186/s12885-021-08936-9nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flowShinichi Kinami0Naohiko Nakamura1Tomoharu Miyashita2Hidekazu Kitakata3Sachio Fushida4Takashi Fujimura5Tohru Itoh6Hiroyuki Takamura7Department of Surgical Oncology, Kanazawa Medical UniversityDepartment of Surgical Oncology, Kanazawa Medical UniversityDepartment of Surgical Oncology, Kanazawa Medical UniversityDepartment of Gastroenterological Endoscopy, Kanazawa Medical UniversityDepartment of Gastroenterologic Surgery, Kanazawa UniversityDepartment of Surgery, Toyama City HospitalDepartment of Gastroenterological Endoscopy, Kanazawa Medical UniversityDepartment of Surgical Oncology, Kanazawa Medical UniversityAbstract Background The correlation between tumor location and lymphatic flow distribution in gastric cancer has been previously reported, and PTD (Proximal – Transitional – Distal) classification was proposed. Our group updated and developed the nPTD classification. Method We retrospectively studied gastric cancer patients who underwent the dye method sentinel node biopsy from 1993 to 2020. The inclusion criteria were a single lesion type 0 cancer of ≤5 cm in the long axis, clinically node-negative, and invasion within the proper muscle layer pathologically. In this study, the distribution of dyed lymphatic flow was evaluated for each occupied area of the tumor. Results We included 416 patients in this study. The tumors located in the watershed of the right and left gastroepiploic arteries near greater curvature had extensive lymphatic flow; therefore, a newly circular region with a diameter of 5 cm is set on the watershed of the greater curvature between P and T zone as the ‘n’ zone. In addition, for cancers located in the lesser P curvature, lymphatic flow to the greater curvature was not observed. Therefore, the P zone was divided into two: the lesser curvature side (PL) and the greater curvature side (PG). Conclusions The advantage of the nPTD classification is that it provides not only proper nodal dissection but also adequate function-preserving gastrectomy. If the tumor is localized within the PL, the proximal gastrectomy resection area can be further reduced. In contrast, for cancers located in the ‘n’ zone, near-total gastrectomy is required because of the extensive lymphatic flow.https://doi.org/10.1186/s12885-021-08936-9Gastric cancerSentinel node biopsyLymphatic flowFunction preserving gastrectomy |
| spellingShingle | Shinichi Kinami Naohiko Nakamura Tomoharu Miyashita Hidekazu Kitakata Sachio Fushida Takashi Fujimura Tohru Itoh Hiroyuki Takamura nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow BMC Cancer Gastric cancer Sentinel node biopsy Lymphatic flow Function preserving gastrectomy |
| title | nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow |
| title_full | nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow |
| title_fullStr | nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow |
| title_full_unstemmed | nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow |
| title_short | nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow |
| title_sort | nptd classification an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow |
| topic | Gastric cancer Sentinel node biopsy Lymphatic flow Function preserving gastrectomy |
| url | https://doi.org/10.1186/s12885-021-08936-9 |
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