Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection: An Analysis from the US Gastric Cancer Collaborative

Gholami, Sepideh; Janson, Lucas; Worhunsky, David J.; Tran, Thuy B.; Squires, Malcolm H.; Jin, Linda X.; Spolverato, Gaya; Votanopoulos, Konstantinos I.; Schmidt, Carl; Weber, Sharon M.; Bloomston, Mark; Cho, Clifford S.; Levine, Edward A.; Fields, Ryan C.; Pawlik, Timothy M.; Maithel, Shishir K.; Efron, Bradley; Norton, Jeffrey A.; Poultsides, George A.

doi:10.1016/j.jamcollsurg.2015.04.024

Cited by 86 publications

(78 citation statements)

References 23 publications

(31 reference statements)

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“…Our findings support the notion that ACC belongs to the group of abdominal malignancies, including esophageal, gastric, and colon cancer, where a regional lymph node dissection may be associated with a therapeutic benefit in addition to providing more accurate staging. 17–19 …”

Section: Discussionmentioning

confidence: 99%

Lymphadenectomy for Adrenocortical Carcinoma: Is There a Therapeutic Benefit?

et al. 2016

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Background Lymph node metastasis is an established predictor of poor outcome for adrenocortical carcinoma (ACC); however, routine lymphadenectomy during surgical resection of ACC is not widely performed and its therapeutic role remains unclear. Methods Patients undergoing margin-negative resection for localized ACC were identified from a multi-institutional database. Patients were stratified into 2 groups based on the surgeon’s effort or not to perform a lymphadenectomy as documented in the operative note. Clinical, pathologic, and outcome data were compared between the 2 groups. Results Of 120 patients who met inclusion criteria from 1993 to 2014, 32 (27 %) underwent lymphadenectomy. Factors associated with lymphadenectomy were tumor size (12 vs. 9.5 cm; p = .007), palpable mass at presentation (26 vs. 12 %; p = .07), suspicious lymph nodes on preoperative imaging (44 vs. 7 %; p < .001), and need for multivisceral resection (78 vs. 36 %; p <.001). Median number of lymph nodes harvested was higher in the lymphadenectomy group (5.5 vs. 0; p < .001). In-hospital mortality (0 vs. 1.3 %; p =.72) and grade 3/4 complication rates (0 vs. 12 %; p = .061) were not significantly different. Patients who underwent lymphadenectomy had improved overall survival (5-year 76 vs. 59 %; p = .041). The benefit of lymphadenectomy on overall survival persisted on multivariate analysis (HR = 0.17; p = .006) controlling for adverse preoperative and intraoperative factors associated with lymphadenectomy, such as tumor size, palpable mass, irregular tumor edges, suspicious nodes on imaging, and multivisceral resection. Conclusions In this multicenter study of adrenocortical carcinoma patients undergoing R0 resection, the surgeon’s effort to dissect peritumoral lymph nodes was independently associated with improved overall survival.

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Section: Discussionmentioning

confidence: 99%

Lymphadenectomy for Adrenocortical Carcinoma: Is There a Therapeutic Benefit?

et al. 2016

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“…According to the previous studies as well as SEER data, the total number of retrieved lymph nodes is significantly correlated with prognosis [23, 24]. Two main reasons for dissecting a recommended number of lymph nodes are that this helps to standardize the surgical procedure and discover more metastatic lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Age-specific effects on the prognosis after surgery for gastric cancer: A SEER population-based analysis

Song

Jiang

et al. 2016

Oncotarget

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Prognosis of age at diagnosis for gastric cancer (GC) has been investigated in a few studies with inconclusive results. To assess the survival of GC across different age groups, we searched the Surveillance, Epidemiology, and End Results (SEER) database (1988-2010) and identified 10,092 patients undergoing gastrectomy. Analyses of the associations between age and 5-year GC-specific survival (GCSS) were carried out using the Kaplan-Meier method and Cox regression model. When the 50-59 year age group was used as reference group, patients younger than 50 years suffered similar survival rates, and the risk of death increased for patients older than 60 years (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.02-1.20), peaking for ages > 80 years (HR, 1.60; 95% CI, 1.46-1.76). Overall, HRs of 5-year GCSS increased steadily with age, even when age was evaluated as a continuous variable. We assessed the survival differences associated with age between three groups, using the cut-off ages of 30 and 50 years. Compared with the elderly group, a high survival rate was observed in the mid-age group, but not in the youngest group. Stratified analysis for sex, race, tumor site, histology and clinical stage yielded consistent results. This study shows that the prognosis of GC varies with age, and young GC patients appear to have a favorable GCSS after surgical treatment. Further studies are warranted to verify our findings.

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“…The mortality rate for gastrectomy performed for any intent was 0% -21%; the mortality rate for non-resection surgeries was 0%-39% 43 . In the literature update, which included all moderate-quality studies, procedure-related mortality for gastrectomy performed in noncurative studies was 1.1% -9.1% 44,48 ; the mortality rate for non-resection surgeries in noncurative studies was 4.8%-10% 21,47 .…”

Section: Key Evidence For Recommendationmentioning

confidence: 99%