Effectiveness of paraaortic lymph node dissection for advanced gastric cancer

Abstract

Background/aims: To evaluate the effectiveness of paraaortic lymph node dissection (D4) for gastric cancer from the viewpoint of long-term results.

Methodology: Among 879 patients who underwent gastrectomy for advanced gastric cancer, 130 patients who underwent D4 lymphadenectomy were evaluated in relation to clinicopathological findings and long-term results.

Results: The frequency of histological paraaortic lymph node metastasis (n4) was 23.1% (30/130). The cumulative 5-year survival rate of 30 n4 patients with D4 lymphadenectomy was 16.7%, which was higher than that (4.2%) of n4 patients without D4 (sampling of paraaortic lymph nodes). Among n4 patients with D4 lymphadenectomy, the cumulative survival rate in 8 patients with 1-2 paraaortic lymph nodes involved (5-year survival rate: 50%) was significantly higher than that in 21 patients with 3 or more paraaortic lymph nodes involved (5-year survival rate: 4.6%). According to the intra-operative macroscopic extent of lymph node metastasis, the cumulative survival rate of patients who were judged as N2 was higher than that of patients judged as N4.

Conclusions: Paraaortic lymph node dissection for advanced gastric cancer was effective, especially when it was done prophylactically and when the number of paraaortic lymph node metastases were 2 or less.