title: [Disciplinarian of lymph node metastasis and effect of paraaortic lymph nodes dissection on clinical outcomes in advanced gastric carcinoma].
abstract: OBJECTIVE
  To investigate the disciplinarian of lymph node metastasis and evaluate the effect of paraaortic lymph nodes dissection on the clinical outcomes in advanced gastric carcinoma.
  
  
  METHODS
  One hundred and twenty-six patients who underwent D(3) (including D(3)(+)) radical resection (group D(3)) and 146 patients who underwent D(2) radical resection by the same surgical team (group D(2)) for advanced gastric cancer were enrolled in the present study. The dissected lymph nodes were grouped according to the definition of Japanese Research Society for the Study of Gastric Cancer (JRSGC) (Edition 13th). The lymph node metastasis was analyzed in group D(3). The clinicopathological characteristics and clinical outcomes were compared between the two groups.
  
  
  RESULTS
  There were no differences in age, sex, tumor location, Borrman type, histological type and TNM stage between group D(2) and group D(3) (P > 0.05). The No16 lymph node metastatic rate was 3.8%, 22.3%, 46.8% and 32.1% in T(1), T(2), T(3), T(4) stage tumors respectively, 16.3% and 69.5% in the patients with negative and positive serosal invasion respectively; there were no differences in operative mortality (2/126 vs 2/146) and surgical complications (4/126 vs 6/146) between group D(2) and group D(3) (P > 0.05). The 5-year survival rate was 66.5% in group D(3) and 40.2% in group D(2) (P< 0.01). The 5-year survival rates of the patients with I, II, IIIa, IIIb and IV stage tumors who were No16 lymph nodes negative were 94.8%, 95.6%, 72.1%, 58.6%, 59% respectively in group D(3), and 42%, 36%, 27%, 35.6%, 16.3% respectively in group D(2). The 5-year survival rate of the patients with No16 (+) lymph nodes less than 3 was higher than that of the patients with No16(+) lymph nodes more than 3.
  
  
  CONCLUSIONS
  No16a2 and No16b1 are the common locations of lymph node metastasis in advanced gastric cancer. The paraaortic lymph node metastasis closely is related with the depth of tumor invasion and serosal invasion. Paraaortic lymph nodes dissection (D(3) or D(3)(+) radical resection) improves the 5-year survival rate of the patients with No16 (-) and No16 (+) lymph nodes less than 3.
authors.affiliation: Department of Gastrointestinopancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China. wenhuazh@21cn.com
authors.forename: Wen-hua
authors.initials: WH
authors.lastname: Zhan
authors.forename: Fang-hai
authors.initials: FH
authors.lastname: Han
authors.forename: Yu-long
authors.initials: YL
authors.lastname: He
authors.forename: Yu-ming
authors.initials: YM
authors.lastname: Li
authors.forename: Zhang-qing
authors.initials: ZQ
authors.lastname: Zheng
authors.forename: Jun-sheng
authors.initials: JS
authors.lastname: Peng
authors.forename: Shi-rong
authors.initials: SR
authors.lastname: Cai
authors.forename: Jin-ping
authors.initials: JP
authors.lastname: Ma
mesh_terms: D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome