C. Granruth1, P. Friedmann1, P. Muscarella1, J. C. McAuliffe1, H. In1 1Montefiore Medical Center,Department Of Surgery,Bronx, NY, USA
Introduction:
Controversy remains regarding the extent of lymphadenectomy that should be performed at the time of gastrectomy for gastric adenocarcinoma. Although guidelines promote lymph node dissections of ≥15, extended lymph node dissection (ELND) has been reported to confer increased morbidity without oncologic benefit, contributing to poor uptake of this guideline. We utilized the National Cancer Data Base (NCDB) to examine peri-operative mortality and long-term mortality for gastrectomies with ELND compared to those without.
Methods:
Gastric adenocarcinoma patients diagnosed between 2004 and 2013 were identified. Analysis was limited to patients who were candidates for ELND, including ages of 18 – 74, stage II or III, and without any Charlson comorbidities. Demographis and outcomes were compared between patients who had ELND (≥16) to those who did not. Logistic regression, Kaplan-Meier and Cox regression analyses were performed using SAS 9.4 (Cary, NC).
Results:
Of 10,921 patients, 5,364 (49.12%) underwent ELND. They were more likely to be treated at academic/research institutions (48.64% vs. 37.92%), higher volume hospitals (25.82 vs. 17.01), and to have been transferred prior to treatment (55.59% vs. 49.90%). They were more likely to be stage III (64.60% vs. 53.14%), have tumor size >40mm (59.71% vs. 52.80%), and have positive regional lymph nodes (83.59% vs. 74.21%). Multivariate analyses showed that ELND was associated with improved 30-day mortality [aOR: 0.783 (95% CI: 0.607-1.009)], 90-day mortality [aOR: 0.694 (95% CI: 0.579-0.832)], and overall survival [aHR: 0.788 (95% CI 0.749-0.829)].
Conclusion:
We found improved peri-operative outcomes in those patients undergoing ELND. While these findings may reflect that ELND is more commonly performed in specialized centers, they suggest that ELND is safe, should be performed in appropriately selected patients.
