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PROGNOSTIC FACTORS AND LONG-TERM RESULTS FOLLOWING LAPAROSCOPIC GASTRECTOMY AND LYMPHADENECTOMY FOR THE TREATMENT OF GASTRIC CANCER: A SINGLE CENTER STUDY.
Adriana Ruano Campos^*, Aida Elisa Pérez Jiménez, Daniel Rivera Alonso, Cristina Sánchez del Pueblo, Pablo Talavera Eguizabal, Antonio J. Torres, Esteban Martín Antona, Andrés Sánchez-Pernaute
Digestive surgery, Hospital Clínico San Carlos, Madrid, Spain
Introduction:
Laparoscopy in the surgical treatment of gastric cancer has demonstrated well known advantages. However, there is still controversy regarding oncological results and standards of this approach.

Methods:
We conducted a retrospective study on 68 patients with confirmed gastric cancer diagnosis who underwent laparoscopic gastrectomy with lymphadenectomy in our center. Demographic data of patients, preoperative chemotherapy, tumor location and characteristics, surgical technique, post-operative complications and tumor staging were analysed.

Results:
Median age of patients was 70 years and 60.3% were females. Subtotal gastrectomy was carried out on 75% of cases, performing D2 lymphadenectomy on 80.9% with a median number of 26 nodes resected (range: 29-35). 23.9% of patients received preoperative chemotherapy due to locally advanced disease. 24.2% were stage III postoperatively. Complications appeared in 39.7% of patients, being the majority (65.4%) classified as Clavien-Dindo I-II. Preoperative chemotherapy, tumor location, positive nodal status (N+) and lymph node ratio were analysed as prognostic factors. 39.7% presented positive nodal status, which was associated to a median node ratio of 0.1. 14.5% of patients recurred, 5 of which presented distant metastasis and 4 local recurrences. 25.9% of patients with positive nodal status recurred (p 0.012), 16.7% of which received preoperative chemotherapy. Recurrence was also related to a mean node ratio of 0.2, whereas those patients who were free of disease during follow-up presented a node ratio of 0.0 (p 0.004). Node ratio >0.03 predicted recurrence with a 77.8% sensitivity and 73.1% specificity. There were no significant differences between tumor location and recurrence rate. Median disease-free survival rate was 17 months and overall survival rate was 67.5 months. At 5-year follow-up, 77.7% of patients remain alive.

Conclusions:
Long-term survival rate is a key indicator for evaluating oncological outcomes. This sample of our findings provides additional data concerning laparoscopic gastric cancer resection and lymphadenectomy, nowadays performed more safely and with acceptable oncological outcomes in specialised centres. The extent of lymphadenectomy achieved by current laparoscopic procedures excels gold standards for correct staging. Furthermore, our results showed nodal ratio to be a good prognostic factor with statistically significant outcomes. To date, small number of studies have analysed which N stage is best as prognostic predictor, concluding, as in our study, that nodal ratio is a reliable adjunct.

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