Is There Any Role of Additional Retropancreatic Lymph Node Dissection on D2 Gastrectomy for Advanced Gastric Cancer?

Abstract

Extended lymph node dissection beyond D2 in resectable gastric cancer has not shown any survival benefits. However, whether the retropancreatic (No. 13) lymph node should be dissected still remains controversial. The purpose of this study was to evaluate the effects of additional No. 13 lymph node dissection on D2 gastrectomy for gastric cancer in terms of overall survival. From May 2001 to December 2006, 528 patients underwent curative resection for the middle- or lower-third advanced gastric cancer at the National Cancer Center, Korea. The patients were grouped according to whether a No. 13 lymphadenectomy was performed (13D+/13D-). Clinicopathological characteristics and treatment-related factors were compared between the two groups. The overall survival was analyzed using the Cox proportional hazard model. The incidence of No. 13 lymph node metastasis was 6.7%. There was no significant difference in morbidity or mortality between the 13D+ and 13D- groups. In clinical stages I/II, No. 13 lymph node dissection did not affect overall survival. However, it was an independent prognostic factor in patients with clinical stages III/IV gastric cancer (hazard ratio (HR), 0.55; P=0.022). Additional retropancreatic lymph node dissection beyond a D2 gastrectomy might be favorable for survival in patients with clinical stage III/IV middle- or lower-third gastric cancer.