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. 2025;42(4):160-173.
doi: 10.1159/000546436. Epub 2025 May 19.

The Association between the Number of Retrieved Lymph Nodes and Survival in Gastric Cancer Surgery: A Dutch Population-Based Study

Wei Keat Ooi  1   2 , Sander J M van Hootegem  1 , Low Kuan Yean  1   2 , Leonie R van der Werf  3 , Pieter C van der Sluis  1 , Sjoerd M Lagarde  1 , Bas P L Wijnhoven  1
Affiliations

The Association between the Number of Retrieved Lymph Nodes and Survival in Gastric Cancer Surgery: A Dutch Population-Based Study

Wei Keat Ooi et al. Dig Surg. 2025.

Abstract

Introduction: This study aimed to evaluate whether the retrieval of 15 or more lymph nodes (LN) during gastrectomy for cancer is associated with better survival and more accurate pathological staging.

Methods: Patients that underwent gastrectomy between 2011 and 2016 were reviewed from the Dutch Upper Gastrointestinal Cancer Audit. Patients with <15 and ≥15 LN retrieved were compared after propensity-score matching based on patient and tumor characteristics. The primary endpoint was 3-year overall survival.

Results: A total of 2,047 patients were included in the study. After propensity score matching, 522 patients with ≥15 LNs were matched to 522 patients with <15 LNs. There was no statistically significant difference in overall survival between both groups with 3-year survival rates of 56% versus 59%, respectively. Patients with ≥15 LNs had a more advanced pN-category. While median survival was higher for patients with ≥15 LNs versus <15 LNs in the subgroups pN2, pN3a, and pN3b, no statistically significant differences were found. Similar results were found in the propensity score matched cohort using 23 LNs as cut-off.

Conclusion: ≥15 LNs retrieved during gastrectomy for cancer was associated with higher pN-stage, likely as a result of stage migration. Three-year overall survival was comparable for patients with ≥15 LNs and patients with <15 LNs retrieved.

Keywords: Gastric cancer; Lymph node retrieval; Lymphadenectomy; Prognosis; Propensity score matching.

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Conflict of interest statement

Pieter Christiaan van der Sluis and Bas P.L. Wijnhoven were both a member of the journal’s Editorial Board at the time of submission.

Figures

Fig. 1.
Fig. 1.
Flowchart of patient inclusion and propensity score matching. Clinical TNM tumor stage according to the TNM-7 classifications. DUCA, Dutch Upper GI Cancer Audit; ASA, American Society of Anesthesiologists; BMI, body mass index.
Fig. 2.
Fig. 2.
Overall survival curves with 95% confidence interval of the subgroups <15 LNs versus ≥15 LNs in the propensity matched cohort.
Fig. 3.
Fig. 3.
Overall survival according to pN-category for patients in the propensity matched cohort with < 15 lymph nodes (a) and ≥15 lymph nodes (b).
Fig. 4.
Fig. 4.
a–d Overall survival of the subgroups <15 versus ≥15 lymph nodes in the propensity matched cohort stratified for pN-category. The pN3b category was omitted because its classification requires retrieval of at least 15 lymph nodes.
See this image and copyright information in PMC

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