Over D1 lymph-nodes dissection may question the value of post-operative radiotherapy as a part of an adjuvant program in radically resected gastric cancer patients

Abstract

4041 Background: The aim of our study was to asses the effect on local relapse, and consequently on overall and disease free survival, of a limited or an extended lymphadenectomy, in an homogeneus group of radically resected gastric cancer patients. This analysis was performed in order to identify a subgroup of patients possibly not benefiting from a toxic therapeutic approach such chemoradiation therapy. Methods: Patients with radically resected gastric cancer were eligible for our analysis. We divided our patients into 2 groups according to lymphadenectomy type: group A for limited (25 or less than 25 resected lymph nodes) and group B for extended (more than 25 resected lymph nodes) lymph nodes resection. All major clinical characteristics (age, extension within gastric wall, pN stage and extent of lymphadenectomy) were considered for statistical analysis. Results: Four hundred-eighteen patients were analysed: tumour stage at diagnosis was pT2–3 pN1–3 M0 in 339 patients and pT3 N0 M0 in 79 patients. Median age at diagnosis for the whole group was 68 years (range 30–92 years). Three hundred-six patients (73.2%) underwent limited (group A) and 112 (26.8%) extended (group B) lymph nodes dissection. Local recurrence occurred in 21% of patients in group A and in 4.7% of those in group B (p=0.0001). The median survival time (OS) for patients in group A and group B were respectively 58.8 months and 84.8 months (p=0.0371); disease free survivall (DFS) were respectively 28.8 and 59.9 months (p=0.0027). At multivariate analysis extension within the gastric wall, nodal involvement and the number of resected lymph nodes appeared to affect both OS and DFS. Conclusions: Our findings suggest that an inadequate lymph nodes resection can affect survival and result in a higher incidence of local relapse, thus making this latter group of patients optimal candidates for adjuvant chemoradiation. On the other hand, after a R0 resection with an adequate lymphadenectomy, adjuvant chemoradiotherapy should not be recommended outside of prospective randomised trials. No significant financial relationships to disclose.