The Impact Of No.14v Lymph Node Dissection On The Prognosis Of Patients With Distal Gastric Cancer Without Chemotherapy In Stage ?B And ?

Objective: By analyzing the risk factors that affect the prognosis of patients with ?B and ?,and the survival prognosis of patients with non chemotherapy,the necessity of cleaning No.14 v lymph nodes for patients with ?B and ? is discussed.Methods: The clinical and pathological data of 340 patients with D2 radical gastrectomy from May 2012 to March 2015 in the First Affiliated Hospital of Guangxi Medical University were retrospectively collected.According to whether to dissect the No.14 v lymph nodes,they were divided into the Un-dissected Group and the Dissected Group.Using the method of propensity score matching,200 patients were selected from the enrolled patients according to the matching accuracy of 1:1.Objective to analyze the effect of No.14 v lymph node dissection on survival and prognosis of patients with distal ?B or ? stage chemotherapy.Results:ASA classification(P=0.01),Borromann type(P=0.012),N stage(P=0.042)are differences between the two groups was statistically significant before the Propensity Score Matching(P<0.05).There was no significant difference in clinical pathological data between the two groups after propensity score matching(P>0.05).The single factor analysis before the Propensity Score Matching showed that age,Charlson score,the amount of bleeding,and dissection of No.14 v lymph nodes were related to the prognosis of the patients,and the difference was statistically significant(P<0.01).Multivariate COX analysis showed that age,Charlson score and dissection of No.14 v lymph nodes were independent prognostic factors for survival(P<0.05).After Propensity Score Matching,a single factor analysis showed that complications,bleeding volume and No.14 v lymph node dissection were related to the prognosis of patients.(P<0.05).Multivariate COX analysis revealed whether postoperative complications and No.14 v lymph node dissection were independent prognostic factors for survival(P<0.05).Interaction analysis suggested that No.14 v lymph node dissection in patients with T4 a tumor(HR 0.3,95%CI 0.2-0.5,P<0.01)and tumor did not break through the serosa(HR 0.3,95%CI 0.1-0.5,P<0.01).The risk of poor prognosis was lower than that of the uncleared patients.Conclusion:(1).No.14 v lymph node dissection can improve the overall survival rate of patients with distal gastric cancer after ?B and ? chemotherapy.(2).Whether tumor breaks through the serosa is an important barrier to the prognosis of patients with advanced gastric cancer.No.14 v lymph node dissection for patients who did not break through the serosa would reduce the risk of poor prognosis in patients with distal gastric cancer at stage ?B and ? without chemotherapy.(3).Whether postoperative complications,bleeding volume and No.14 v lymph node dissection were the risk factors for the prognosis of patients with distal gastric cancer at stage ?B and ? without chemotherapy.Whether there is postoperative complications and whether No.14 v lymph node dissection is an independent prognostic factor for survival in patients with ?B or ? stage of distal gastric cancer without chemotherapy.