Lymph node metastasis in gastric cancer: Result of D2 dissection

Abstract

Background: Extent of lymph node dissection still remains one of the most controversial issues regarding radical gastrectomy. Knowledge of the pattern and incidence of lymph node metastasis may help to define the optimal extent of lymph node dissection. Material and Method: The authors analyzed lymph node metastasis and survival rate in 130 consecutive gastric cancer patients who underwent radical gastrectomy with D2 dissection between June 2001 and October, 2008 at the Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. Results: For N staging, 28.5% of the patients were N0 while N1 was 40% and N2 was 31.5%. 44% of the patients with lymph node positive had metastasis up to group 2 lymph nodes. The patients with node positive had 5 year survival of 39% while the patients with node negative had survival of 73% (p = 0.003). Tumor at the middle part of the stomach had the most widespread lymph node metastasis compared to other regions. Lymph node group 7, 8 and 9 had a high incidence of lymph node metastasis especially for distal cancer while lymph node group 10, 11, 12 had lower incidence of metastasis. No mortality was seen in the present study. Conclusion: N staging, number of metastatic node > 5 and angiolymphatic invasion were the lymph node related factors contributing to survival. For radical gastrectomy, D2 dissection is required for adequate clearance of metastatic lymph nodes, which can be done without mortality.