Gastrectomy: lymph node noncompliance tied to poorer survival

  • Chen QY & al.
  • Ann Surg Oncol
  • 12 Feb 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Patients with gastric cancer undergoing radical gastrectomy who receive noncompliant D2 lymphadenectomy had worse survival, but adjuvant chemotherapy (ACT) was associated with better outcomes in noncompliant patients with pathological stage II disease.

Why this matters

  • D2 dissection is recommended for gastric cancer, but can be challenging due to anatomical complexity and multiple pathways for metastasis. Existing quality indexes to assess D2 dissection vary between centers.

Study design

  • Retrospective analysis of 2401 patients undergoing total gastrectomy (TG, n=1343) or distal gastrectomy (DG, n=1058) at a university in China.
  • Funding: Various nonindustry sources.

Key results

  • Noncompliance was defined as the patient having more than 1 empty lymph node station, according to the protocol of the Japanese Gastric Cancer Association.
  • Compliance was 61.7% in TG and 33.2% in DG.
  • 3-year survival was better in compliant patients (74.0% vs 60.1%; P<.001>
  • Among 374 pathological stage I patients not recommended for ACT, there was no significant difference in OS between noncompliant patients who did or did not go on to actually receive chemotherapy.
  • Among 77 noncompliant pathological stage II patients (pT1N2/N3M0 and pT3N0M0) not recommended for ACT, eventual chemotherapy was linked to better survival (HR, 0.32; P=.044).

Limitations

  • Retrospective analysis.

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