Valoración del análisis de la pieza operatoria en el cáncer gástrico por el cirujano

Abstract

Background: The systematic dissection of the surgical piece, performed by the surgeon during surgical treatment of gastric cancer, gives information about borders and lymph node involvement. Aim: To determine the concordance between the fi ndings of the surgeon during initial dissection and the fi nal pathological report. Material and Methods: Prospective study of 48 patients aged 64 ± 10 years (74% males) subjected to curative surgery for gastric cancer. Patients were staged according to 2010 TNM classifi cation. Stomach size from the lesser curvature, oral and caudal limits, macroscopic aspect, tumor diameter and lymph node involvement were determined by the surgeon observing the surgical piece. The concordance of this observation with the fi nal pathological report was assessed. Results: Fifty nine percent of patients were subjected to a total gastrectomy and there was a mean of 30 lymph nodes excised. There was a good concordance between surgeon observation and fi nal pathological report for tumor depth (Kappa = 0.64), macroscopic aspect (Kappa = 0.69) and tumor size (Lin = 0.84). There was a bad concordance for lymph node involvement (Kappa = 0.21). The percentage of retraction of lesser curvature length was 24%, 30% for oral and 22% for caudal limits. Conclusions: There is a good concordance between surgeon observation and pathological report for macroscopic aspect, tumor size and depth but the concordance for lymph node involvement is bad.