Comparison of lymph node number and prognosis in gastric cancer patients with perigastric lymph nodes retrieved by surgeons and pathologists

摘要

Objective: To compare the numbers of positive and total lymph nodes and prognosis in gastric cancer patients whose perigastric lymph node retrieval was performed by surgeons and pathologists.Methods: We conducted a retrospective analysis of clinical and follow-up data from 1,056 patients who underwent gastric cancer D2 radical lymph node resection between January 2008 and December 2010 in the Gastrointestinal Surgery Department of Yantai Yuhuangding Hospital.The follow-up ended in December 2015.Patients were divided into two groups according to the specialty of physicians who performed the postoperative perigastric lymph node retrieval: the surgeon group(475 cases) and the pathologist group(581 cases).The numbers of positive and total perigastric lymph nodes and the 3- and 5-year survival were compared between gastric cancer patients in the two groups overall and stratified by TNM stage(AJCC 7th Edition).Results: Overall, the numbers of positive and total lymph nodes were significantly higher in the surgeon group than in the pathologist group(6.53±4.07 vs.4.09±3.70, P=0.021; 29.64±11.50 vs.20.71±8.56, P<0.001).Further analysis showed that the total number of lymph nodes in stage Ⅰ patients(19.40±9.62 vs.15.45±8.59, P=0.011) and the numbers of positive and total lymph nodes in stage Ⅱ(1.38±1.08 vs.0.87±1.55, P=0.031; 25.35±10.80 vs.16.75±8.56, P<0.001) and stage Ⅲ patients(8.11±6.91 vs.6.66±5.12, P=0.026; 32.34±12.55 vs.25.45±8.31, P<0.001)were significantly higher in the surgeon group than in the pathologist group.The survival analysis showed that the3- and 5-year survival of stage Ⅱ and Ⅲ patients was significantly higher in the surgeon group than in the pathologist group(82.0% vs.73.1%, 69.5% vs.61.2%, P=0.038; 49.2% vs.38.9%, 36.3% vs.28.0%; P=0.045).Conclusions: Compared with retrieval performed by pathologists, postoperative perigastric lymph node retrieval performed by surgeons was associated with significant increase in the total lymph node number of stage Ⅰ patients, the numbers of positive and total lymph nodes of stage Ⅱ and Ⅲ patients, and the survival of stage Ⅱ and stage Ⅲ gastric cancer patients.