Metastatic lymph node ratio as a prognostic factor in gastric cancer

BACKGROUND

There is an association between the number of resected lymph node and the number of metastatic lymph nodes in gastric cancer, suggesting that pN category could be influenced by the extension of the lymphadenectomy. This study evaluates this association and proposes a comprehensive use of the ratio as prognostic factor.

METHOD

Review of 183 consecutive patients with gastric adenocarcinoma. The association between the number of resected lymph nodes and the number of metastatic lymph nodes was analysed and evaluated with other prognostic factors.

RESULTS

The number of lymph node metastases increased with the number of resected lymph nodes. The lymph node ratio was a better prognostic factor than the number of metastatic lymph nodes.

CONCLUSIONS

The metastatic lymph node ratio seems to be a good prognostic factor, but needs further evaluation.

[Laparoscopic resection of hepatic hydatid cyst under general anesthesia with remifentanil infusion]

We report the case of a 52-year-old woman who underwent scheduled laparoscopic resection of a hydatid liver cyst under general anesthesia by infusion of remifentanil and sevoflurane. Surgery was uneventful, although invasive monitoring was required, just as it would have been in major open abdominal surgery, given the risk of bleeding secondary to organ manipulation, the risk of anaphylactic shock related to the etiology of the cyst and the possibility of gas embolism related to laparoscopy. The concept of "minimally invasive" surgery has developed thanks to continued progress in laparoscopy. The considerable advantages of such procedures in comparison with "open" or "conventional" surgery has led to their use with organs such as the liver, which in principle require caution. In such cases, the anesthesiologist must take an approach that is not as simple or minimalist as the term "minimally invasive" might lead us to expect.