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Harvest of at Least 23 Lymph Nodes is Indispensable for Stage N3 Gastric Cancer Patients

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The National Comprehensive Cancer Network (NCCN) recommends that at least 15 lymph nodes (LNs) be removed during radical gastrectomy. This study aims to investigate the optimal number of LNs resected for radical gastrectomy.

Patients and Methods

From September 2008 to March 2015, a total of 1990 gastric cancer patients were enrolled in this study. Clinicopathological features and survivals were recorded, and the association between the number of LNs resected and the prognosis of gastric cancer were analyzed.

Results

Overall, 1520 males (76.4%) and 470 females (23.6%) were included in the study, with a median age of 57 years (range 20–90). The median number of LNs resected was 24 (range 15–83) for stage N1, 25 (range 15–62) for stage N2, 25 (range 15–88) for stage N3a, and 28 (range 16–73) for stage N3b. The optimal cut-off value for the number of LNs resected was 22 for stage N3a (p = 0.000) and N3b (p = 0.003) patients, while no other cut-off value was significantly superior to 15 for stage N1–2 patients (both p > 0.05). Age, tumor size, tumor depth, and number of LNs resected were independent prognostic predictors for stage N3a patients, while resection type and number of LNs resected were independent prognostic predictors for stage N3b patients. Removing more than 22 LNs exhibited a significant survival benefit compared with removing 15–22 LNs for stage N3a and N3b patients (29.7 vs. 21.6%, p = 0.000; 12.9% vs. 0%, p = 0.003, respectively).

Conclusion

Removing at least 23 LNs could yield better survival outcomes in stage N3 gastric cancer patients.

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Acknowledgement

The authors thank the study participants in each of the individual studies for their involvement.

Funding

This study was supported in part by grants from the National Natural Scientific Foundation of China [Numbers 31100643, 31570907, 81300301, 81572306, 81502403, XJZT12Z03].

Disclosure

Gaozan Zheng, Fan Feng, Man Guo, Guanghui Xu, Shushang Liu, Zhen Liu, Li Sun, Liu Hong, Jianjun Yang, Xiao Lian, Daiming Fan, and Hongwei Zhang have no financial or other relations that could lead to a conflict of interest.

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Author notes

    Authors and Affiliations

    1. Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi’an, Shaanxi, China

      Gaozan Zheng MM, Fan Feng MD, Man Guo BMed, Guanghui Xu MM, Shushang Liu MM, Zhen Liu MM, Li Sun MD, Liu Hong MD, Jianjun Yang MD, Xiao Lian MStat, Daiming Fan PhD & Hongwei Zhang PhD

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    1. Gaozan Zheng MM
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    2. Fan Feng MD
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    3. Man Guo BMed
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    Corresponding authors

    Correspondence to Fan Feng MD or Hongwei Zhang PhD.

    Additional information

    Gaozan Zheng, Fan Feng, and Man Guo contributed equally to this work.

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    Zheng, G., Feng, F., Guo, M. et al. Harvest of at Least 23 Lymph Nodes is Indispensable for Stage N3 Gastric Cancer Patients. Ann Surg Oncol 24, 998–1002 (2017). https://doi.org/10.1245/s10434-016-5667-4

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    • DOI: https://doi.org/10.1245/s10434-016-5667-4

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