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

• Published in: Chinese medical journal 2014, Vol.127 (3), p.435-441
• Main Authors: Zhang, Changhua, He, Yulong, Schwarz, Roderich E, Smith, David D, Wang, Liang, Liu, Fakeng, Zhan, Wenhua
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Humans; Lymph Node Excision; Male; Middle Aged; PAN; Prophylactic Surgical Procedures - methods; Stomach Neoplasms - surgery; Treatment Outcome; Young Adult; 多变量分析; 晚期; 淋巴结; 胃癌; 腹主动脉; 节点; 评价
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.20130664

Background Prophylactic 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.Methods Between 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.Results The 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）.Conclusion Extended D2 lymphadenectomy plus PAND is associated with superior outcomes for advanced gastric cancer patients with 1-3 involved PANs.