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[Effectiveness of para-aortic lymph node dissection for advanced gastric cancer]
Wen-hua Zhan1, Yu-long He, Zhang-qing Zheng
1Department of Gastrointestinopancreatic Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Objective:
To assess whether any correlation exists between survival and the extent of lymph-node dissection.
Methods:
D(2), D(2)(+) or D(3) radical resection was performed on 158 patients with advanced gastric cancer. Among them, 73 were subjected to para-aortic lymph node dissection, (PALD group), and the other 85 were not subjected to the operation (non-PALD group). There was no significant difference in age, gender, site of tumors, type of Borrmann and histology between the two groups. The PALD group showed more advanced diseases in term of tumor invasion, lymph node metastasis and clinicopathological stage.
Results:
Average operation time was longer in the PALD group than in the non-PALD group [(280 +/- 93) min VS. (245 +/- 91) min, (P < 0.01)]. Blood transfusion volume was (693 +/- 324) ml in the PALD group, and (460 +/- 375) ml in the non-PALD group (P < 0.01). No anastomotic leaks, pancreatic fistula, abdominal abscess and ileus were observed in both groups. No significant complications were found except for a higher incidence of diarrhea in the PALD group. Significant difference was found in survival curve, mean and median survival time between the two groups. The difference in survival was also found between patients with positive and negative lymph node metastasis in the PALD and non-PALD groups. Again, there was significant difference in survival between positive and negative No. 16 lymph node in the PALD group.
Conclusion:
Para-aortic lymph node dissection offers a significant survival benefit to curable patients with advanced gastric cancer. It is similar to limited lymphadenectomy in morbidity and mortality.