C. Rog1, L. Brubaker1, C. Hsu1, E. Silberfein1 1Baylor College Of Medicine,Surgical Oncology,Houston, TX, USA
Introduction: Nodal stage remains one of the most important prognostic factors for patients with gastric cancer and the National Comprehensive Cancer Network (NCCN) recommends that a minimum of 15 lymph nodes be resected for accurate staging. Furthermore, recent studies suggest that the number of nodes resected may correlate with survival. We examined the oncologic outcomes of lymph node harvest in an inner city, indigent, minority population with gastric cancer.
Methods: A retrospective consecutive cohort study of 71 patients undergoing gastrectomy with curative intent at a single county hospital between 2001 and 2017 was performed. Patients were divided into three groups based on the number of lymph nodes harvested. Groups 1-3 included fewer than 15 nodes resected, between 15 and 25 nodes resected, and greater than 25 nodes resected, respectively. Demographic, pathologic, and survival data were compared between groups.
Results: There were 12, 17 and 32 patients in groups 1-3 respectively. The median numbers of nodes resected in each group were 12, 16 and 31 respectively. There were no differences in median age, sex, type of surgery (total vs subtotal gastrectomy), tumor grade, pathologic T stage, node positive rate or clinical stage between groups. Patients in group 3 had significantly higher N stage (p=0.03). At a median follow up of 1036 days, there were no significant differences in survival for all stages between the 3 groups (p=0.125).
Conclusion: We did not observe significant differences in survival with respect to number of lymph nodes resected for gastric cancer patients at our institution. This may not be surprising, however, as the surgical procedures performed for these patients remained fairly consistent, and therefore the cohorts were stratified by the number of nodes identified by the pathologist as opposed to any inherent difference in therapy. Likewise, our data do not suggest that more precise staging improved survival outcomes. Retrospective studies correlating lymph node count with improved survival should be interpreted with caution.
