Role of lymph node dissection and splenectomy in node-positive gastric carcinoma.

BACKGROUND

In gastric carcinoma the relationship between survival of patients and degree of lymph node dissection is still controversial and there is no agreement about the efficacy of extended lymph node dissection and splenectomy.

METHODS

Long-term results after surgery were statistically analyzed in 240 patients who underwent curative gastrectomy with lymph node dissection for node-positive gastric carcinoma from 1975 to 1990.

RESULTS

The survival of patients was not significantly different among R1, R2, and R3 dissections, with the 10-year survival rate being 57%, 50%, and 44%, respectively. The survival rate was also not different between R2 and R3, even when the cases were stratified by the level of lymph node metastasis (N1, 66% vs 58%; N2, 28% vs 31%). The survival of patients was not significantly different between cases treated without splenectomy and those treated with splenectomy, with 10-year survival rates being 47% and 26%, respectively. The survival rate was also not different between non-splenectomy- and splenectomy-treated cases, even when the patients were compared in the same level of lymph node metastasis (N1, 60% vs 45%; N2, 23% vs 11%).

CONCLUSIONS

In cases of curative gastrectomy the survival time of patients was not influenced by the level of lymph node dissection and splenectomy. For the treatment of node-positive gastric carcinoma (N1, N2) the long-term efficacy of R3 dissection and splenectomy seems limited.