The survival benefit of extended lymphadenectomy in the surgical treatment of gastric cancer has not been established.
In this study, researchers from Italy evaluated long-term survival in a group of patients with involvement of second level lymph nodes. These would not have been removed in the case of a limited lymphadenectomy.
The team compared the results with those in patients with involvement of first level lymph nodes.
They assessed 451 patients with primary gastric cancer who underwent curative resection with extended lymphadenectomy according to the rules of the Japanese Research Society for Gastric Cancer, between 1991 and 1997.
|Only positive lymph node number and depth of invasion found to be predictors of poor prognosis.|
|Annals of Surgical Oncology|
The research team found morbidity and mortality rates to be 17% and 2%, respectively.
In 28% of patients (group A), metastases were found in lymph node stations 7 to 12, while 24% of patients had metastases confined to the first level (group B).
The team also found that lymph node stations 7 and 8 showed the highest incidence of metastases in the second level (17% and 12%, respectively).
The researchers identified a significant difference in 5-year survival between group A (32%) and group B (54%).
However, this difference disappeared when cases were stratified according to the number of positive lymph nodes.
When compared using multivariate analysis, only the number of positive lymph nodes and the depth of invasion, were independent predictors of poor prognosis.
The level of involved nodes was not shown to be a predictive factor.
Dr Franco Roviello's team concluded, "Japanese-type extended lymphadenectomy yields low morbidity and mortality rates if performed in specialized centers".
"This procedure could provide a good probability of long-term survival, even for patients with involvement of regional lymph nodes".