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Fat clearance of upper gastrointestinal resection specimens increases lymph node yield and may result in nodal upstaging
  1. Jon Griffin,
  2. Clare Bunning,
  3. Asha Dubé
  1. Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Jon Griffin, Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; jon.griffin{at}


Introduction Lymph node retrieval and quantification is an important element in staging upper gastrointestinal cancers. Our department introduced fat clearance for oesophagectomy and gastrectomy specimens in 2014. This study assessed the impact of this change on lymph node yield and upstaging.

Methods We reviewed histopathology data for upper gastrointestinal resection specimens. Patient demographics, clinical, macroscopic and microscopic data were compared with a historical cohort who did not undergo fat clearance.

Results Of 158 patients, 133 resection specimens received fat clearance resulting in a significantly higher lymph node yield than the historical cohort (22 vs 13 lymph nodes, p<0.0001). Fat clearance found additional positive nodes in 24.1% of patients and increased the number of cases achieving a minimum node yield of 15. Nodes found by fat clearance caused upstaging in 15% of the cohort.

Discussion Fat clearance increases node yield in upper gastrointestinal resection specimens and may cause nodal upstaging.

  • histopathology
  • gastric cancer
  • metastasis

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  • Handling editor Dhirendra Govender.

  • Contributors All authors were involved equally in the experimental design, data collection, data analysis and writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data are available.