title: Prognostic Influence of the Extent of Lymph Node Dissection and Perioperative Comorbidities in Patients with Gastric Cancer.
abstract: BACKGROUND
  The proportion of geriatric gastric cancer (GC) patients with comorbidities has been increasing in Japan. This study was designed to evaluate the prognostic influence of the extent of lymph node dissection (END) and perioperative morbidities in patients with GC.
  
  
  METHODS
  Between 2008 and 2013, total of 167 patients with GC who underwent curative gastrectomy were enrolled in the study. Clinicopathological findings including the END and perioperative morbidities were analyzed.
  
  
  RESULTS
  An analysis of the relationship between clinical factors and END revealed that undergoing limited END (n=26) was associated with greater age (≥75 years) (p=0.036), preoperative nodal metastasis (p=0.005), and preoperative comorbidities (p=0.003). Moreover, a multivariate analysis identified preoperative nodal metastasis (p=0.001) and preoperative comorbidities (p=0.002) as independent factors for undergoing limited END. A prognostic analysis of END revealed that those who underwent limited END had a significantly poorer prognosis than the group that underwent standard END (n=141) (p=0.032); however, limited END was not an independent factor for a poor prognosis. A prognostic analysis of END and postoperative complications in patients with GC with preoperative comorbidities showed that patients who underwent standard END without postoperative complications had the most favorable prognosis (5-year survival rate; 85.3%), while those who underwent limited END with postoperative complications had the worst prognosis (5-year survival rate=30.0%).
  
  
  CONCLUSIONS
  END correlated with patient-related factors but was not associated with postoperative complications. High-risk patients with GC may be indicated for standard END without risk of postoperative morbidity.
authors.affiliation: Department of Surgery, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan t-kwgch@koto.kpu-m.ac.jp.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kawaguchi
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.affiliation: Department of Surgery, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan.
authors.forename: Y U
authors.initials: YU
authors.lastname: Kimura
authors.affiliation: Department of Surgery, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan.
authors.forename: Sousuke
authors.initials: S
authors.lastname: Komiyama
authors.affiliation: Department of Surgery, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Konishi
authors.affiliation: Department of Surgery, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kin
authors.affiliation: Department of Surgery, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan.
authors.forename: Sadao
authors.initials: S
authors.lastname: Kawakami
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kosuga
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy; D006499:Hepatic Artery; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000601:surgery*
keywords: Gastric cancer; comorbidity; extent of lymph node dissection; morbidity; prognosis