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World J Gastroenterol. Jul 14, 2008; 14(26): 4216-4221
Published online Jul 14, 2008. doi: 10.3748/wjg.14.4216
Effect of lymphadenectomy extent on advanced gastric cancer located in the cardia and fundus
Chang-Ming Huang, Bi-Juan Lin, Hui-Shan Lu, Xiang-Fu Zhang, Ping Li, Jian-Wei Xie
Chang-Ming Huang, Bi-Juan Lin, Hui-Shan Lu, Xiang-Fu Zhang, Ping Li, Jian-Wei Xie, Department of Oncology, Affiliated Union Hospital of Fujian Medical University, Fuzhou 350001, Fujian Province, China
Author contributions: Huang CM and Lin BJ conceived the study, analyzed the data, and wrote the draft of the manuscript and submitted the manuscript; Lu HS and Zhang XF helped revise the manuscript critically for important intellectual content; Li P and Xie JW helped collect data and design the study.
Correspondence to: Chang-Ming Huang, Department of Oncology, Affiliated Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou 350001, Fujian Province, China. hcmlr253@sohu.com
Telephone: +86-591-87118266
Fax: +86-591-83320319
Received: April 23, 2008
Revised: May 16, 2008
Accepted: May 23, 2008
Published online: July 14, 2008
Abstract

AIM: To analyze the prognostic impact of lymphade-nectomy extent in advanced gastric cancer located in the cardia and fundus.

METHODS: Two hundred and thirty-six patients with advanced gastric cancer located in the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. Relationships between the numbers of lymph nodes (LNs) dissected and survival was analyzed among different clinical stage subgroups.

RESULTS: The 5-year overall survival rate of the entire cohort was 37.5%. Multivariate prognostic variables were total LNs dissected (P < 0.0001; or number of negative LNs examined, P < 0.0001), number of positive LNs (P < 0.0001), T category (P < 0.0001) and tumor size (P = 0.015). The greatest survival differences were observed at cutoff values of 20 LNs resected for stage II (P = 0.0136), 25 for stage III(P < 0.0001), 30 for stage IV (P = 0.0002), and 15 for all patients (P = 0.0024). Based on the statistically assumed linearity as best fit, linear regression showed a significant survival enhancement based on increasing negative LNs for patients of stages III (P = 0.013) and IV (P = 0.035).

CONCLUSION: To improve the long-term survival of patients with advanced gastric cancer located in the cardia and fundus, removing at least 20 LNs for stage II, 25 LNs for stage III, and 30 LNs for stage IVpatients during D2 radical dissection is recommended.

Keywords: Stomach neoplasms; Lymph node metastasis; Surgery; Lymphadenectomy; Prognosis