title: Paraaortic lymph node dissection for gastric cancer in 244 consecutive cases.
abstract: 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.
authors.affiliation: Department of General & Gastrointestinal Surgery, School of Medicine Kanazawa Medical University, Ishikawa-ken, Japan. tkosaka@kanazawa-med.ac.jp
authors.forename: Takeo
authors.initials: T
authors.lastname: Kosaka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Usami
authors.forename: Nobuo
authors.initials: N
authors.lastname: Ueshige
authors.forename: Taisuke
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Yoshitani
authors.forename: Junichi
authors.initials: J
authors.lastname: Sugaya
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Nakano
authors.forename: Shigeki
authors.initials: S
authors.lastname: Takashima
mesh_terms: 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