title: Implication of extended lymph node dissection stratified for advanced gastric cancer.
abstract: BACKGROUND
  What extent of lymph node dissection for advanced gastric cancer is appropriate is a matter of controversy.
  
  
  METHODS
  Three hundred and ninety-nine gastric cancer patients underwent potentially curative D2 gastrectomy and 125 underwent D3 gastrectomy between 1985 and 1998.
  
  
  RESULTS
  Our study revealed that pN3, but not D3 gastrectomy, significantly influenced prognosis. There was no significant difference in the 5-year survival rate and mean survival time between D2 and D3 patients: but the survival in D3 patients with tumor diameters measuring 50-100 mm or with pN1 was significantly longer than that in D2 patients with the same tumors. Analysis of survival of patients with tumor diameters measuring 50-100 mm revealed that there was a significant difference only in pN1. The incidence of lymphatic recurrence was significantly lower in D3 patients with pN1 tumor or a tumor measuring 50-100 mm than in D2 patients.
  
  
  CONCLUSIONS
  Patients with advanced gastric cancer measuring 50-100 mm and pN1 may benefit from para-aortic lymph node dissection.
authors.affiliation: Second Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. s0714@med.yokohama-cu.ac.jp
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Masazumi
authors.initials: M
authors.lastname: Takahashi
authors.forename: Masato
authors.initials: M
authors.lastname: Nomura
authors.forename: Goro
authors.initials: G
authors.lastname: Matsuda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Otsuka
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Ono
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Akiyama
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate