Abstract
BackgroundThis study aimed to investigate the sufficient (≥ 16) lymph node assessment in 449 patients with gastric adenocarcinoma and literature review.MethodsFour hundred and forty-nine patients with pathologically confirmed locoregional invasive gastric adenocarcinoma from 2004 to 2013 were included. A standard surgical resection was performed for all the patients with (n = 16) or without (n = 433) neoadjuvant treatment.ResultsIn this study, 301 men and 148 women with a median age of 58 (range 21–88) years were included. The median total numbers of examined lymph nodes were 9 (range 0–55). Ninety-five patients (21.2%) had adequate (≥ 16) lymph node examination, and 70 patients (15.6%) had no examined lymph nodes. In univariate analysis, total or near total gastrectomy (P < 0.001), advanced node stage (P < 0.001), primary tumor size > 6 cm (P < 0.001), and the presence of perineural invasion (P = 0.039) were associated with more average number of examined lymph nodes. On multivariate analysis, node stage (P < 0.001) and type of surgery (P = 0.008) were independent predictive factors.ConclusionIn this study, approximately one in five patients with gastric adenocarcinoma had sufficient lymph node assessment. More studies are suggested for identifying a true inadequate lymph node dissection from insufficient lymph node assessment.
Highlights
This study aimed to investigate the sufficient (≥ 16) lymph node assessment in 449 patients with gastric adenocarcinoma and literature review
Total or near total gastrectomy, advanced primary tumor and node stage, tumor size > 6 cm, and the presence of perineural invasion were associated with more median number of examined lymph nodes
No residual tumor (R0) resection is an ultimate goal; there has been strong argue regarding the degree of lymph node (LN) dissection
Summary
This study aimed to investigate the sufficient (≥ 16) lymph node assessment in 449 patients with gastric adenocarcinoma and literature review. Despite a decline in incidence of gastric cancer in the western countries, it is still a major malignant disease [1]. In most countries, this malignancy present at late stage due to undefined risk factors and non-specific symptoms. No residual tumor (R0) resection is an ultimate goal; there has been strong argue regarding the degree of lymph node (LN) dissection. This argument involves sufficient surgical and pathological staging and satisfactory adjuvant therapy. Limited LN dissection (D1) involves perigastric LNs surrounded by 3 cm from the primary tumor, extended LN dissection (D2) extends the dissection outside D1 to include LNs surrounding the hepatic and splenic arteries, and superextended LN
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