Paraaortic lymph node dissection for gastric cancer in 244 consecutive cases.
OBJECTIVE
More than 20% of patients with advanced gastric cancer show paraaortic lymph node metastasis. However, whether extensive paraaortic lymphadenectomy is beneficial remains controversial. We performed a prospective study of paraaortic lymphadenectomy for patients with advanced gastric cancer.


METHODS
From January 1991 to March 2004, 244 consecutive patients with advanced gastric cancer underwent gastrectomy with paraaortic lymphadenectomy with curative intent. The patients were divided into 3 groups according to the period: Group 1 (1991-1995), Group 2 (1996-1999), and Group 3 (2000-2004).


RESULTS
Overall mortality rate was 2.4%, and it fell rapidly from 7.1% in Group 1 to 0% in Group 3. Postoperative complications occurred in 35.6%. High age and postoperative complications were significant predictive factors for operative death. Preoperative comorbidity, positive distal margin, and pancreatectomy were significant predictive factors of postoperative complications. Depth of cancer invasion was correlated with paraaortic node metastasis. Ten patients with paraaortic node metastases survived for more than 5 years. Operative curability and postoperative complications were significant prognostic factors for patients who underwent this procedure.


CONCLUSIONS
Paraaortic lymph node dissection for gastric cancer should be performed in patients with tumors deeper than the serosa. Pancreatectomy should be avoided, with careful management required in cases of unavoidable pancreatectomy.
Kosaka
Takeo
T
Department of General & Gastrointestinal Surgery, School of Medicine Kanazawa Medical University, Ishikawa-ken, Japan. tkosaka@kanazawa-med.ac.jp
Usami
Kazuo
K
Ueshige
Nobuo
N
Hasegawa
Taisuke
T
Yoshitani
Shinichiro
S
Sugaya
Junichi
J
Nakano
Yasuharu
Y
Takashima
Shigeki
S
D000368:Aged; D001011:Aorta; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome