title: Improved survival after adding dissection of the superior mesenteric vein lymph node (14v) to standard D2 gastrectomy for advanced distal gastric cancer.
abstract: BACKGROUND
  Extended lymph node dissection in gastric cancer (D3) was proven to have no survival benefit compared with a D2 dissection, but whether adding the superior mesenteric nodes (No. 14v) to the dissection provides survival benefit for gastric cancer patients remains controversial.
  
  
  METHODS
  From April 2001 to June 2007, 1,661 patients underwent curative resection for middle or lower third gastric cancer. Patients were grouped according to No. 14v lymphadenectomy (14vD+/14vD-). Clinicopathologic characteristics and treatment-related factors were compared between the groups. Overall survival according to the clinical stage (Union for International Cancer Control tumor-node-metastasis staging 6th edition) was analyzed using the Cox proportional hazard model.
  
  
  RESULTS
  The incidence of No. 14v lymph node metastasis was 5.0%. There was no difference in morbidity or mortality between the 14vD+ and the 14vD- groups. The proportion of locoregional recurrence was greater in 14vD- group (P = .018). In clinical stages I and II, 14v lymph node dissection did not affect overall survival; in contrast, 14v lymph node dissection was an independent prognostic factor in patients with clinical stage III/IV gastric cancer (hazard ratio, 0.58; 95% confidence interval, 0.38-0.88; P = .01).
  
  
  CONCLUSIONS
  Extended D2 gastrectomy including No. 14v lymph node dissection seems to be associated with improved overall survival of patients with clinical stage III/IV gastric cancer in the middle or lower third of the stomach.
authors.affiliation: Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Bang Wool
authors.initials: BW
authors.lastname: Eom
authors.affiliation: Biometric Research Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Jungnam
authors.initials: J
authors.lastname: Joo
authors.affiliation: Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea. Electronic address: gskim@ncc.re.kr.
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reim
authors.affiliation: Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Park
authors.affiliation: Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Hong Man
authors.initials: HM
authors.lastname: Yoon
authors.affiliation: Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.affiliation: Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Jong Yeul
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Gastric Cancer Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008642:Mesenteric Veins; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome