The role of lymphadenectomy in curative surgery for gastric cancer

Abstract

Abstract A total of 530 cases of gastric cancer treated by curative surgery was analyzed with regard to lymph node metastases and survival rate. During this period, curative resections made up 75.9% of all resections (530/698) for gastric cancer, and the 5‐year survival rate was 50.6% (268/530). A total of 15,739 regional lymph nodes (an average of 30 per specimen) removed at surgery were examined histologically for metastases, and 16.0% were found to be positive. Of 339 patients with advanced, transmural cancers, 74.9% had lymph node métastases; those with negative nodes had a 5‐year survival rate of 63.5%, while those with positive nodes had a 5‐year survival rate of 29.9%. The 5‐year survivors with positive nodes made up 58.5% of all 5‐year survivors. The almost complete removal of at least the primary and secondary lymph node groups draining a gastric neoplasm is an essential part of the curative surgical treatment of gastric cancer. For lesions in the upper and middle portions of the stomach that invade the serosa of the posterior wall, total gastrectomy with a caudal hemipancreatectomy and splenectomy should be aggressively performed, so as to accomplish complete en bloc removal of the lymph nodes in these regions.