title: Candidates for curative resection in advanced gastric cancer patients who had equivocal para-aortic lymph node metastasis on computed tomographic scan.
abstract: BACKGROUND
  The aim of this study was to determine how to select potential candidates for curative resection among advanced gastric patients with equivocal findings of para-aortic lymph node metastasis on computed tomography (CT).
  
  
  METHODS
  We analyzed the clinicopathologic results of 23 advanced gastric cancer patients who were diagnosed as having equivocal findings of para-aortic lymph node metastasis on a CT scan and who underwent gastrectomy with D2 and para-aortic lymph node dissection.
  
  
  RESULTS
  Twenty-two patients were male, and one patient was female. The median age of all study subjects was 52 years (range, 31-75 years). Sixteen underwent total gastrectomy, and seven underwent subtotal gastrectomy. The median number of A2 (suprarenal) lymph nodes harvested was 2 (range, 1-5), and that of B1 (infrarenal) lymph nodes was 6 (range, 1-17). Ten (43.5%) of the 23 patients were proven pathologically to have metastasis to para-aortic lymph nodes. Two patients with cT2 cancer had no metastatic para-aortic lymph node, whereas three patients with cT4 disease had metastatic para-aortic lymph nodes (P = .021). Seven (70.0%) of 10 patients with pathologic para-aortic lymph node metastasis experienced recurrence, whereas only 2 (15.4%) of 13 patients without experienced recurrence (P = .008). The Lauren classification was found to be an independent predictor of para-aortic lymph node metastasis (relative risk; .13; 95% confidence interval, .02-.83; P = .03).
  
  
  CONCLUSIONS
  More than half of gastric cancer patients with equivocal findings of para-aortic lymph node metastasis on CT are potential candidates for curative resection. The Lauren classification of gastric cancer in patients with equivocal CT findings of para-aortic lymph node metastasis would be helpful when deciding on clinical stage and treatment plans in these patients.
authors.affiliation: Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, 809 Madul-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 411-769, Korea.
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Yong Hae
authors.initials: YH
authors.lastname: Paik
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
authors.forename: Ho Joon
authors.initials: HJ
authors.lastname: Song
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.forename: Sook Ryeon
authors.initials: SR
authors.lastname: Park
authors.forename: Myoung Cheorl
authors.initials: MC
authors.lastname: Kook
authors.forename: Young Woo
authors.initials: YW
authors.lastname: Kim
authors.forename: Jae-Moon
authors.initials: JM
authors.lastname: Bae
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed