[Lymph node dissection in gastric cancer]

ABSTRACT

To review local experience in dissecting regional lymph nodes during gastric cancer surgery and it's impact on prognosis and 5 years survival. This was a retrospective study of all patients having gastric resection for cancer at the University of Damascus hospitals between 2001 and 2007. 180 patients were reviewed with age ranging from 30 to 70 years, and a 21 male predominance [120 males and 60 females]. Patients were divided into three groups according to the level of lymph nodes dissected 1-Dissection of the lymph nodes adjacent to the gastric wall and the nodes around the celiac and hepatic trunks [N3]. 2-Dissection of adjacent and celiac nodes [N2]. 3-Dissection of adjacent nodes only [N1]. Over five years follow up, local recurrence was observed three times more in the third group compared with the first two, with the lowest observed recurrence noted in the group having all three levels dissected. The number of nodes dissected during total gastrectomy was twice as that in patients having sub-total resections. There was a direct correlation between 5 years survival rates in patients having all three levels of lymph nodes dissected and the number of involved lymph nodes. It is advisable to dissect of all the three levels of nodal drainage basins during gastric resection for cancer to reduce local recurrence and therefore to improve survival. Regardless of the type of gastric resection performed, the number of total lymph nodes dissected should not be less than 15 nodes