Candidates for curative resection in advanced gastric cancer patients who had equivocal para-aortic lymph node metastasis on computed tomographic scan.

Abstract

BACKGROUND:

The aim of this study was to determine how to select potential candidates for curative resection among advanced gastric patients with equivocal findings of para-aortic lymph node metastasis on computed tomography (CT).

METHODS:

We analyzed the clinicopathologic results of 23 advanced gastric cancer patients who were diagnosed as having equivocal findings of para-aortic lymph node metastasis on a CT scan and who underwent gastrectomy with D2 and para-aortic lymph node dissection.

RESULTS:

Twenty-two patients were male, and one patient was female. The median age of all study subjects was 52 years (range, 31-75 years). Sixteen underwent total gastrectomy, and seven underwent subtotal gastrectomy. The median number of A2 (suprarenal) lymph nodes harvested was 2 (range, 1-5), and that of B1 (infrarenal) lymph nodes was 6 (range, 1-17). Ten (43.5%) of the 23 patients were proven pathologically to have metastasis to para-aortic lymph nodes. Two patients with cT2 cancer had no metastatic para-aortic lymph node, whereas three patients with cT4 disease had metastatic para-aortic lymph nodes (P = .021). Seven (70.0%) of 10 patients with pathologic para-aortic lymph node metastasis experienced recurrence, whereas only 2 (15.4%) of 13 patients without experienced recurrence (P = .008). The Lauren classification was found to be an independent predictor of para-aortic lymph node metastasis (relative risk; .13; 95% confidence interval, .02-.83; P = .03).

CONCLUSIONS:

More than half of gastric cancer patients with equivocal findings of para-aortic lymph node metastasis on CT are potential candidates for curative resection. The Lauren classification of gastric cancer in patients with equivocal CT findings of para-aortic lymph node metastasis would be helpful when deciding on clinical stage and treatment plans in these patients.

• Authors: Jun Ho Lee, Yong Hae Paik, Jong Seok Lee, Ho Joon Song, Keun Won Ryu, Chan Gyoo Kim, Sook Ryeon Park, Myoung Cheorl Kook, Young Woo Kim, Jae-Moon Bae
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 13 Issue 9 Pg. 1163-7 (Sep 2006) ISSN: 1068-9265 [Print] United States
• PMID: 16952027 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Female
• Gastrectomy
• Humans
• Lymph Node Excision
• Lymph Nodes (diagnostic imaging, pathology)
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Invasiveness (pathology)
• Neoplasm Recurrence, Local (diagnostic imaging)
• Neoplasm Staging
• Prognosis
• Prospective Studies
• Retrospective Studies
• Stomach Neoplasms (diagnostic imaging, pathology, surgery)
• Survival Rate
• Tomography, X-Ray Computed