Evaluation of para-aortic nodal dissection for locoregionally advanced gastric cancer with 1-3 involved para-aortic nodes.
BACKGROUND
Prophylactic para-aortic nodal dissection (PAND) has no proven benefits for potentially curable advanced gastric cancer. However, the value of therapeutic PAND for involved para-aortic nodes (PANs) in patients with locally advanced gastric cancers has not been determined yet.


METHODS
Between 1998 and 2010, 157 gastric cancer patients with 1-3 involved PANs underwent extended D2 (D2+) lymphadenectomy plus PAND (PAND group, n = 69) or extended D2 lymphadenectomy alone (non-PAND group, n = 88). The clinicopathologic features and prognostic data were compared between the two groups. A propensity score-adjusted analysis was used for a balanced comparison.


RESULTS
The rate of PAN metastasis was 40.6% (28/69) in the PAND group. The 5-year survival rate was significantly higher in the PAND group than in the non-PAND group (43.7% vs. 31.8%, P = 0.044). Compared to the non-PAND group, the death hazard ratios in the PAND group were 0.45 (95% CI 0.274-0.739; P = 0.002) and 0.536 (95% CI 0.328-0.861; P = 0.0097) by multivariate analysis without and with propensity score adjustment respectively. Recurrence rate at 5 years was 39.1% in the PAND group and 43.2% in the non-PAND group (P = 0.628).


CONCLUSIONS
Extended D2 lymphadenectomy plus PAND is associated with superior outcomes for advanced gastric cancer patients with 1-3 involved PANs.
Department of Gastrointestinopancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Gastric Cancer Center of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Changhua
C
Zhang
Department of Gastrointestinopancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Gastric Cancer Center of Sun Yat-sen University, Guangzhou, Guangdong 510080, China. Email: ylh@medmail.com.cn.
Yulong
Y
He
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
Roderich E
RE
Schwarz
Division of Biostatistics, City of Hope National Medical Center, Duarte, CA 91010, USA.
David D
DD
Smith
Department of Gastrointestinopancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Gastric Cancer Center of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Liang
L
Wang
Department of Gastrointestinopancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Gastric Cancer Center of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Fakeng
F
Liu
Department of Gastrointestinopancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Gastric Cancer Center of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Wenhua
W
Zhan
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D065286:Prophylactic Surgical Procedures / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult