The aim of this work was to determine the frequency and localization of lymph node involvement and the prognostic value of extensive node dissection on survival in patients with cancer of the stomach.
Type of study: Prospective study from 1981 to 1991 evaluating node dissection in adenocarcinoma of the stomach.
Patients: There were 179 gastrectomies during the 10-years study period including 100 performed as a curative treatment. The tumour was located in the lower part of the stomach in 48 cases, in the upper part in 25 cases in the middle part in 22 cases and involved the entire organs in 5 cases.
Methods: Distal subtotal gastrectomy (DSG) was performed in 45 cases, total gastrectomy (TG) in 16 and total gastrectomy extended beyond the stomach (TGE) in 33 cases. Polar gastrectomy (PG) was used in 6 cases. Type R2 node dissection was done for 90 patients and R1 dissection for 10.
Results: The tumour extended to the mucosa-submucosa (T1) in 17 cases, the musculosa (T2) in 22 cases, the serous membrane (T3) in 45 cases and to adjacent organs (T4) in 16 cases. A mean 18 nodes was examined per surgical specimen and node involvement was found in 59. The localizations showed that the coronary and hepatic chains (n. 7 and 8) were invaded at a rate comparable with the perigastric nodes (n. 3 and 6). The splenic chain was invaded in 1 patient out of 5 with localizations in the mid and upper portions. Corrected overall survival was 49% at 5 years. Survival depended on the node extension (p < 0.0002): survival reached 73% when no metastasis was found and fell to 48% with perigastric node involvement and 30% when the pedicular nodes were invaded. Survival was also a function of tumour stage (p < 0.0002): for T1 tumours it was 89%, for T2 86% and for T3 32%. Multivariance analysis (Cox) showed that parietal extension and node involvement were risk factors with a relative risk of 3.53 and 1.44 respectively.
Conclusion: Extensive node dissection of the pedicular chains should improve survival without increasing morbidity or mortality in the treatment of cancer of the stomach.