Gastric cancer: which patients benefit from systematic lymphadenectomy?

Aims: The purpose of this study was to evaluate the value of systematic lymphadenectomy (SLA) in curative resected gastric cancer patients with respect to long-term survival, peri-operative morbidity and mortality.Methods: We reviewed our prospectively gathered database of 309 resected gastric cancer patients and analysed the outcome of 185 R0-resected patients (60%) with respect to peri-operative morbidity, mortality and long-term survival by comparing 81 patients resected with SLA (D2-group) versus 104 patients resected without SLA (D1-group).Results: Overall 5-year survival rates of R0-resected patients (n=173; exclusion of peri-operative mortality) amounted to 49% and did not differ significantly between D2- and D1-groups (53%vs 47%P=0.344). Nevertheless, subgroups of patients taking a benefit from SLA could be defined. Gastric cancer patients without LN metastases (pTxpN0n=78) and patients with LN metastases only in perigastric lymph nodes (pTxpN1n=34) showed a significantly better long-term prognosis when SLA was performed (84%vs 51%P=0.001). Regarding peri-operative morbidity (38%vs 39%) and mortality (6% in each case) we could not find any differences between the D2- and D1-groups. Conclusions: We conclude that SLA is able to improve long-term survival for some tumour stages. Therefore SLA should be recommended as a standard procedure in all gastric cancer patients resected with curative intention.