Modified radical lymphadenectomy without splenectomy in patients with proximal gastric cancer: comparison with standard D2 lymphadenectomy for distal gastric cancer.

摘要

BACKGROUND AND OBJECTIVES: We assessed the optimal extent of lymph node dissection and the effect of splenectomy in patients with proximal gastric cancer. METHOD: Recurrence and survival rates were compared between 881 patients with proximal gastric cancer who underwent modified radical lymphadenectomy and 3,098 patients with distal gastric cancer who underwent standard D2 lymphadenectomy. RESULTS: The recurrence rate was significantly higher in the total than in the distal gastrectomy group (32.5% vs. 16.5%, P < 0.001), but the rates were similar after adjustment for TNM stage. The overall 5-year survival rate was significantly higher in the distal than in the total gastrectomy group (80.4% vs. 66.2%, P < 0.001), but this difference was not observed after adjustment for TNM stage. Multivariate analysis showed that patient age, number of retrieved lymph nodes, depth of invasion, and nodal metastasis were independent prognostic determinants for survival, whereas type of lymphadenectomy was not. CONCLUSION: Long-term outcomes were similar in patients with proximal gastric cancer who underwent modified lymphadenectomy without splenectomy and in patients with distal gastric cancer who underwent standard D2 lymphadenectomy. These findings indicate that modified radical lymphadenectomy without splenectomy is sufficient for optimal lymph node dissection in patients with proximal gastric cancer.