title: Gastric cancer: which patients benefit from systematic lymphadenectomy?
abstract: OBJECTIVE
  The purpose of this study was to evaluate the value of systematic lymphadenectomy (SLA) in curative resected gastric cancer patients with respect to long-term survival, peri-operative morbidity and mortality.
  
  
  METHODS
  We reviewed our prospectively gathered database of 309 resected gastric cancer patients and analysed the outcome of 185 R0-resected patients (60%) with respect to peri-operative morbidity, mortality and long-term survival by comparing 81 patients resected with SLA (D2-group) versus 104 patients resected without SLA (D1-group).
  
  
  RESULTS
  Overall 5-year survival rates of R0-resected patients (n = 173; exclusion of peri-operative mortality) amounted to 49% and did not differ significantly between D2- and D1-groups (53% vs 47%); P=0.344). Nevertheless, subgroups of patients taking a benefit from SLA could be defined. Gastric cancer patients without LN metastases (pTx pN0; n=78) and patients with LN metastases only in perigastric lymph nodes (pTx pN1; n=34) showed a significantly better long-term prognosis when SLA was performed (84% vs 51%; P=0.001). Regarding peri-operative morbidity (38% vs 39%) and mortality (6% in each case) we could not find any differences between the D2- and D1-groups.
  
  
  CONCLUSIONS
  We conclude that SLA is able to improve long-term survival for some tumour stages. Therefore SLA should be recommended as a standard procedure in all gastric cancer patients resected with curative intention.
authors.affiliation: Department of General and Trauma Surgery, Heinrich Heine University, Düsseldorf, Federal Republic Germany.
authors.forename: N M
authors.initials: NM
authors.lastname: Bösing
authors.forename: P E
authors.initials: PE
authors.lastname: Goretzki
authors.forename: H D
authors.initials: HD
authors.lastname: Röher
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome