Effectiveness of paraaortic lymph node dissection for advanced gastric cancer.
OBJECTIVE
To evaluate the effectiveness of paraaortic lymph node dissection (D4) for gastric cancer from the viewpoint of long-term results.


METHODS
Among 879 patients who underwent gastrectomy for advanced gastric cancer, 130 patients who underwent D4 lymphadenectomy were evaluated in relation to clinicopathological findings and long-term results.


RESULTS
The frequency of histological paraaortic lymph node metastasis (n4) was 23.1% (30/130). The cumulative 5-year survival rate of 30 n4 patients with D4 lymphadenectomy was 16.7%, which was higher than that (4.2%) of n4 patients without D4 (sampling of paraaortic lymph nodes). Among n4 patients with D4 lymphadenectomy, the cumulative survival rate in 8 patients with 1-2 paraaortic lymph nodes involved (5-year survival rate: 50%) was significantly higher than that in 21 patients with 3 or more paraaortic lymph nodes involved (5-year survival rate: 4.6%). According to the intra-operative macroscopic extent of lymph node metastasis, the cumulative survival rate of patients who were judged as N2 was higher than that of patients judged as N4.


CONCLUSIONS
Paraaortic lymph node dissection for advanced gastric cancer was effective, especially when it was done prophylactically and when the number of paraaortic lymph node metastases were 2 or less.
Isozaki
H
H
First Department of Surgery, Okayama University Medical School, Japan.
Okajima
K
K
Fujii
K
K
Nomura
E
E
Izumi
N
N
Mabuchi
H
H
Nakamura
M
M
Hara
H
H
D001011:Aorta; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010534:Peritoneal Neoplasms / Q000556:secondary; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome