Prognostic Impact Of Lymphadenectomy Extent On Advanced Gastric Cancer Located In Cardia And Fundus

Aim: To analyze the prognostic impact of lymphadenectomy extent on advanced gastric cancer located in cardia and fundus.Methods:236 patients with advanced gastric cancer located in cardia and fundus who underwent D2 curative resection were analyzed retrospectively.Relationships between the number of lymph nodes (LNs) dissected and postoperative survival outcomes were analyzed for the entire cohort and the stage subgroups characterized by the N categories, T categories.Results:The 5-year overall survival rate of the entire cohort was 37.5%. Total LN count dissected (or number of negative LNs examined; P < 0.0001), number of positive LNs (P < 0.0001), T category (P < 0.0001) and tumor size (P = 0.015) were independent prognostic survival predictors. Among those patients of same stage, the more LNs were dissected or more negative LNs were found, the better survival outcomes achieved(P<0.05). A cut point analysis yielded the ability to detect significant survival differences. Best long-term survival outcomes were observed with LN counts of more than 20 for stage II(P=0.0136), more than 25 for stage III(P<0.0001) ,more than 30 for stage IV(P=0.0002)or more than 15 for the entire cohort (P=0.0024), with greatest comparative discrepancies. Based on the statistically assumed linearity as best fit, the linear regression showed a statistically significant survival enhancement based on increasing negative LN numbers for patients of stages IIIand stages IV(P<0.05).The postoperative complication rate was 15.7%, and its recurrence was not statistically significant correlated with dissected lymph node number (P=0.101).The overall recurrence rates of 236 patients was 61.0% within 5 years of surgery, which was also analyzed by the number of negative LNs resected. The recurrence rates generally decreased when more LNs removed. And there were statistically significant differences between LN count categories(P<0.05).Conclusions: Total LNs dissected and number of negative LNs can help predict survival for advanced gastric cancer located in cardia and fundus. To improve long-term therapeutic effects,adequate lymph node accout,including total LNs and number of negative LNs,is recommended during D2 radical dissection.