GASTRIC-CARCINOMA - DOES LYMPH-NODE DISSECTION ALTER SURVIVAL

BACKGROUND: Extragastric lymphadenectomy (D2 node dissection) is stron gly supported by Japanese data to have survival benefit. Randomized tr ial data are either inconclusive or nonsupportive of this view. We hav e reviewed a prospectively gathered database of 18,346 cases of gastri c carcinoma from a gastric cancer patient care evaluation study conduc ted by the American College of Surgeons to assess whether the performa nce of extragastric node dissection was associated with improved survi val in patients who had resection with curative intent (all margins mi croscopically clear). STUDY DESIGN: We reviewed a subgroup of patients with curatively resected gastric carcinoma and com pared the outcome in patients having extragastric lymph node dissection with the outcome in patients who did not have dissection of N2 nodes. RESULTS: Among t he 3,804 patients having curative resection in the long-term study wit h more than a five-year follow-up, 695 had dissection of the nodes alo ng the celiac axis, hepatic artery, or splenic artery (N2 nodes); 1,52 9 patients had removal of the adjacent nodes (N1 nodes) along the gast ric tube or the gastric or perigastric nodes (N1 nodes); and 903 patie nts who had no nodes identified in the resection specimen (essentially N0 nodes removed). For patients having a dissection of N2 nodes, the median survival time was 19.7 months with a five-year survival rate of 26.3 percent; for patients having a dissection of N1 nodes, the media n survival time was 24.8 months with a five-year survival rate of 30 p ercent; among patients having no nodes removed, the median survival ti me was 29.5 months with a five-year survival rate of 35.6 percent. CON CLUSIONS: Lymph node dissection (D2) of N2 nodes did not augment survi val compared with gastrectomy without node dissection or that included perigastric nodes in the resection, Subgroup analysis of patients wit h gastric carcinoma having a curative resection did not show benefit o f the extragastric node dissection (D2), Continued study is warranted and the data from ongoing clinical trials may yield more conclusive in formation.