Does the number of lymph nodes harvested reflect the width of lymphadenectomy in gastric carcinoma? Results of a prospective comparative study

Objective: The aim of this study was to evaluate the sufficiency of the surgical technique according to the extended lymph node dissection in gastric cancer patients (GCPs). We supported our findings with the determination of number of lymph nodes (LNs) in lymph node stations with an autopsy performed on cadavers without any type of cancer. Method: 55 GCPs were enrolled. Extended lymphadenectomy was performed on 23 autopsy cases as a comparative group. Total gastrectomy and D2 dissection was performed as the standard surgical approach. Results: According to TNM classification, nine cases (18%) were stratified to stage I, three (6%) to stage II, 22 (36%) to stage III, and 21 (40%) to stage IV. The median number of excised LNs from the 55 cases was 47 (24-95), metastatic LNs were 15 (1-71) in patients. In the autopsy group the median number was 72 (50-91). If D1 dissection had been performed instead of D2 dissection in the 55 cases, the median number of excised LNs would have been 24 (10–57) and metastatic LNs would have been 5 (1–45). If D1 dissection had been performed in the autopsy group, the median number of excised LNs would have been 36 (20–49). Conclusions: The number of LNs harvested does not reflect the width of lymphadenectomy. D2 dissection must be performed stationary to achieve adequate extension of the lymphadenectomy. Possible skip metastasis and stage migration will be also reduced so that more efficient oncological results will be achieved