Abstracts
1997 Digestive Disease Week

Extended lymphadenectomy is associated with a survival benefit for node-negative gastric cancer.

LE Harrison, MS Karpeh, MF Brennan. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.

The purpose of this study is to determine whether D2 dissection is associated with a survival benefit for histologically node negative gastric cancer at a tertiary cancer center in the United States.

Methods: Review of the prospective gastric database at Memorial Sloan-Kettering Cancer Center from 7/85 to 8/95 identified 774 patients who underwent curative gastric resection. Of these, 250 (32%) patients were identified with histologically negative lymph nodes by hematoxylin-esosin staining. Data are expressed as median (range). Survival was calculated by the method of Kaplan-Meier and compared by log rank test.

Results: The in-hospital operative mortality rate was 3.3%. The overall 5 year survival for the entire cohort was 66% with a median survival of 105 months.

                          D1 (n=80)     D2 (n=170)   p value
 # lymph nodes/specimen   12 (1-64)     22 (4-84)     0.001
 Hospital stay            19 (6-81)     17(5-59)      NS
 5 year survival:
         T1               90% (n=44)    93% (n=63)    NS
         T2               87% (n=21)    94% (n=53)    NS
         T3               39% (n=15)    55% (n=54)    0.04

Conclusion: D2 dissection is associated with improved survival for advanced T stage, node negative gastric cancer. With adequate staging, Western results of gastric resection for adenocarcinoma begin to approximate those seen in Japan. Excision of N2 lymph nodes increases staging accuracy and is associated with improved survival in T₃ tumors.