Evaluation of para-aortic nodal dissection for locoregionally advanced gastric cancer with 1-3 involved para-aortic nodes.

Changhua Zhang; Yulong HE; Roderich E Schwarz; David D Smith; Liang Wang; Fakeng Liu; Wenhua Zhan

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Evaluation of para-aortic nodal dissection for locoregionally advanced gastric cancer with 1-3 involved para-aortic nodes.

Author: Changhua ZHANG ^{1
,

2} ; Yulong HE ¹ ; Roderich E SCHWARZ ³ ; David D SMITH ⁴ ; Liang WANG ¹ ; Fakeng LIU ¹ ; Wenhua ZHAN ¹ ;
Author Information

1. Department of Gastrointestinopancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
2. Gastric Cancer Center of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
3. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
4. Division of Biostatistics, City of Hope National Medical Center, Duarte, CA 91010, USA.
Publication Type:Journal Article
MeSH: Adult; Aged; Female; Humans; Lymph Node Excision; Male; Middle Aged; Prophylactic Surgical Procedures; methods; Stomach Neoplasms; surgery; Treatment Outcome; Young Adult
From: Chinese Medical Journal 2014;127(3):435-441
CountryChina
Language:English
Abstract:
BACKGROUNDProphylactic para-aortic nodal dissection (PAND) has no proven benefits for potentially curable advanced gastric cancer. However, the value of therapeutic PAND for involved para-aortic nodes (PANs) in patients with locally advanced gastric cancers has not been determined yet.
METHODSBetween 1998 and 2010, 157 gastric cancer patients with 1-3 involved PANs underwent extended D2 (D2+) lymphadenectomy plus PAND (PAND group, n = 69) or extended D2 lymphadenectomy alone (non-PAND group, n = 88). The clinicopathologic features and prognostic data were compared between the two groups. A propensity score-adjusted analysis was used for a balanced comparison.
RESULTSThe rate of PAN metastasis was 40.6% (28/69) in the PAND group. The 5-year survival rate was significantly higher in the PAND group than in the non-PAND group (43.7% vs. 31.8%, P = 0.044). Compared to the non-PAND group, the death hazard ratios in the PAND group were 0.45 (95% CI 0.274-0.739; P = 0.002) and 0.536 (95% CI 0.328-0.861; P = 0.0097) by multivariate analysis without and with propensity score adjustment respectively. Recurrence rate at 5 years was 39.1% in the PAND group and 43.2% in the non-PAND group (P = 0.628).
CONCLUSIONExtended D2 lymphadenectomy plus PAND is associated with superior outcomes for advanced gastric cancer patients with 1-3 involved PANs.