Survival benefits of pancreatoduodenectomy for gastric cancer: relationship to the number of lymph node metastases.
OBJECTIVE
Pancreatoduodenectomy (PD) for advanced gastric cancer is rarely performed because of the high frequency of associated morbidity and mortality. The aim of this study was to determine the limited indication of PD for advanced gastric cancer.


METHODS
From January 1984 and December 2005 patient's charts were reviewed and outcomes after PD for gastric cancer were compared between two subgroups; those with a 'high' number (7<or= group) of lymph node metastases and those with 'low' numbers (6>or= group).


RESULTS
PD was intraoperatively selected because of direct tumor invasion into the pancreas (52.2% of the 7<or= group vs 12.5% of the 6>or= group) or pancreatic lymph node infiltration (47.8% of the 7<or= group vs 87.5% of the 6>or= group; P = 0.058). The postoperative histological analysis showed 22 cases from 23 (95.7%) in 7<or= group with T3 or T4 tumor, compared with only 4 cases (50%) in 6>or= group (P = 0.014). The 5-year survival rates were significantly better in the 6>or= group compared with the 7<or= group (P = 0.014).


CONCLUSIONS
The indication for PD in advanced gastric cancer should consider the degree of extensive lymph node metastases and incurable factors.
Department of Surgery, Cancer Institute Hospital, 10-6 Ariake 3-chome, Koto-ku, Tokyo, 135-8550, Japan.
Souya
S
Nunobe
Naoki
N
Hiki
Shigekazu
S
Ohyama
Tetsu
T
Fukunaga
Yasuyuki
Y
Seto
Toshiharu
T
Yamaguchi
D000368:Aged; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010179:Pancreas / Q000473:pathology; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*