Significance of para-aortic lymph node dissection in advanced gastric cancer

BACKGROUND/AIMS: Since surgical results in advanced gastric cancer remain p oor and para-aortic lymph node dissection may contribute to survival, it is useful to determine the significance of para-aortic lymph node dissection. METHODOLOGY: Para-aortic lymph node dissection was provisionally indicated for patients with invasion depth deeper than the subserosal layer. Clinicop athologic variables were retrospectively analyzed using univariate analysis and multivariate analysis to predict para-aortic lymph node metastasis. Si milarly, they were analyzed using univariate analysis and the Cox's proport ional hazards regression model to estimate the prognostic factor in 120 pat ients who underwent para-aortic lymph node dissection. Surgical results and post-operative complications were compared between para-aortic lymph node dissection and D-2 dissection. RESULTS: Univariate analysis revealed that the mean diameter, the degree of lymph node metastasis, and the invasion depth were significant predictors of para-aortic lymph node metastasis. Multivariate analysis showed that nz was the only independent predictive factor as to para-aortic lymph node met astasis. Univariate analysis revealed tumor site, tumor diameter, lymph nod e metastasis, number of positive lymph nodes, INF, and stage were significa ntly associated with 5-year survival. The Cox's proportional hazards regres sion model showed that the number of positive lymph nodes and the number of positive para-aortic lymph nodes were independent prognostic factors. Pati ents with less than or equal to 10 positive lymph nodes in any stage or les s than or equal to 3 positive para-aortic lymph nodes in stage IVb had sign ificantly better surgical results. Surgical results for patients who underw ent para-aortic lymph node dissection with n2 or invasion depth deeper than the exposed serosa were significantly higher than those in D-2. As to post -operative complications, pancreatic fistula and respiratory complications were significantly frequent after para-aortic lymph node dissection. CONCLUSIONS: n2 is helpful in predicting para-aortic lymph node metastasis. Whereas, post-operative morbidity such as pancreatic fistula and respirato ry complications after para-aortic lymph node dissection were significantly higher, they were controllable. Para-aortic lymph node dissection should b e indicated in advanced gastric cancer patients in which lymph node metasta sis is over n2 or invasion depth is deeper than the exposed serosa. But the number of positive para-aortic lymph nodes must be less than three.