title: Tumor site and perigastric nodal status are the most important predictors of para-aortic nodal involvement in advanced gastric cancer.
abstract: BACKGROUND
  This study was designed to identify pathological predictors of para-aortic nodal invasion in advanced gastric cancer.
  
  
  METHODS
  Between 1990 and 2007, 294 patients with advanced gastric cancer underwent gastrectomy with D2 lymphadenectomy + para-aortic nodal dissection in Siena and Verona, Italy.
  
  
  RESULTS
  Forty-seven (16%) patients had para-aortic node metastases. Of these, 91%, 88%, and 74%, respectively, also had metastases at stations No. 3, No. 1, and No. 7. Para-aortic node metastases were never observed when stations No. 1 and No. 3 were both negative. Patients were divided into three groups, according to the risk of para-aortic node invasion: (1) high-risk group (n = 24, 8.2%), presenting a 42% risk and comprising T3/T4 cancers with mixed/nonintestinal histology, arising from the upper third; (2) low-risk group (n = 138, 46.9%), presenting a 0-10% risk and including middle-lower third tumors-either T2 irrespective of histology, or T3/T4 with intestinal histology; (3) intermediate-risk group, comprising all other patients (n = 132, 44.9%). Their risk ranged between 16% and 30%, but increased up to 21-37.5% after excluding 33 patients with negative No. 1 and No. 3 stations.
  
  
  CONCLUSIONS
  The combination of tumor site, histology, and T stage with perigastric nodal status allowed identification of patients at higher risk of para-aortic nodal invasion who could benefit from para-aortic nodal dissection.
authors.affiliation: First Division of General Surgery, University of Verona, Verona, Italy. giovanni.demanzoni@univr.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Manzoni
authors.forename: Alberto
authors.initials: A
authors.lastname: Di Leo
authors.forename: Franco
authors.initials: F
authors.lastname: Roviello
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.forename: Simone
authors.initials: S
authors.lastname: Giacopuzzi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Minicozzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Verlato
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010220:Para-Aortic Bodies / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate