Background: Adequate lymphadenectomy (LAE) at the time of any cancer operation has become a surrogate for quality patient care. In addition the extent of lymph node dissection in gastric resections has long been debated. Proper resection in gastric cancer should include more than 15 lymph nodes for accurate staging, as this is the threshold for N3 disease by AJCC criteria. We sought to determine if adequate nodal dissection would result in more accurate N staging without an increase in morbidity.
Methods: Data from a prospectively maintained (1/99 - 8/06) foregut malignancy database were reviewed. Patients with a diagnosis of gastric adenocarcinoma (GAC) who underwent resection were included in the study. Factors including extent of resection, number of LN harvested, number of positive LN, estimated blood loss (EBL), intensive care unit (ICU) stay, pre-operative therapy, and need for transfusion were identified. Uni- and multi-variate analyses were then performed to determine the effects of adequate (> 15 lymph nodes harvested) LAE.
Results: Of 126 patients treated surgically 28 with gastric cancer were identified. There were 16 males (57%) and 12 females (43%). 20 were Caucasian. The median age was 60 (range 41-84). The majority (57%) underwent total gastrectomy, with 61% of tumors proximal stomach and 39% distal. The median EBL was 300 ml (range 50-3,000) and median ICU stay was 1 day (range 1-25). 46% of patients had a complication, ranging from malfunctioning j-tube to anastomotic leak, with a median grade of 3 (range 1-3). There were no deaths.19 patients (68%) had >15 nodes harvested. Adequate LAE at the time of operation resulted in LN (+) disease in 72% of patients; in those undergoing less than adequate dissection LN (+) disease was found in 17% (p<0.05). Adequately dissected patients were also more likely to have N2 or N3 disease (p<0.05). These patients had no increased EBL, need for transfusion, or prolonged ICU stay.
Conclusions: Adequate LAE (> 15 lymph nodes harvested) resulted in more accurate nodal staging in patients undergoing resection for GAC. These patients were more likely to have LN (+) disease than N0 disease. In addition, adequate LAE was not associated with increased peri-operative morbidity as determined by operative blood loss, increased need for transfusion, or prolonged ICU stay.
Group Characteristics

	Non-Adequate	Adequate	p value
n	9	19
Node (+)	3	14	0.04
EBL > 500 ml	3	6	ns
ICU Stay > 2 Days	2	5	ns
Complications	4	9	ns