Implication of extended lymph node dissection stratified for advanced gastric cancer.
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.
Kunisaki
Chikara
C
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
Shimada
Hiroshi
H
Takahashi
Masazumi
M
Nomura
Masato
M
Matsuda
Goro
G
Otsuka
Yuichi
Y
Ono
Hidetaka
H
Akiyama
Hirotoshi
H
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