title: A Multidisciplinary Approach for Advanced Gastric Cancer with Paraaortic Lymph Node Metastasis.
abstract: BACKGROUND
  The prognosis for advanced gastric cancer with paraaortic lymph node (PALN) metastasis is very poor even after a curative resection. In the present study, induction chemotherapy followed by curative surgery was performed for advanced gastric cancer with PALN metastasis.
  
  
  METHODS
  Twenty patients with no non-curative factors except PALN metastasis who showed good clinical response for induction chemotherapy were enrolled in the study.
  
  
  RESULTS
  Combined S-1 plus cisplatin chemotherapy was administered to 10 patients; docetaxel, 5-FU plus cisplatin, to 5; S-1 plus paclitaxel to 3; and capecitabine plus cisplatin, to 2 patients. The overall response rate was 80% (16 out of 20 patients responded). All patients underwent curative gastrectomy with extended lymphadenectomy including the PALNs. Out of the 20 patients, 8 survived more than 5 years, and the 3- and 5-year survival rates were 72% and 65%, respectively. Female gender and residual PALN metastasis were significantly associated with worse prognosis and patients with a diffuse-type histology had a tendency to worse prognosis.
  
  
  CONCLUSIONS
  Induction chemotherapy followed by curative surgery including extended PALN dissection seems a promising strategy for advanced gastric cancer with PALN metastasis as a sole distant metastasis, particularly for male patients and those with intestinal-type histology.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka City, Osaka, Japan fujiwara-yo@mc.pref.osaka.jp.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka City, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Omori
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka City, Osaka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Demura
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka City, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka City, Osaka, Japan.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sugimura
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka City, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohue
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka City, Osaka, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka City, Osaka, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka City, Osaka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology* / Q000628:therapy*; D015996:Survival Rate; D055815:Young Adult
keywords: Gastric cancer; extended lymphadenectomy; induction chemotherapy; para-aortic lymph node metastasis