Do preoperative enlarged lymph nodes affect the oncologic outcome of laparoscopic radical gastrectomy for gastric cancer?

Abstract

Background: To investigate the long-term outcome of laparoscopic radical gastrectomy (LAG) for gastric cancer (GC) with preoperative enlarged lymph nodes (LNs).

Materials and Methods: We retrospectively collected data on 855 patients who underwent LAG for GC. The patients were divided into large (>10 mm) and small (≤10 mm) LN groups (LG and SG) based on the preoperative size of the LNs. The outcomes were compared using a 1:1 propensity score-matching method. The enlarged LNs were divided into five areas according to their location.

Results: Before matching, the LG was associated with more retrieved LNs than the SG, whereas after matching, the numbers of LNs retrieved were similar. These numbers remained similar as the number of areas with enlarged LNs increased. Before matching, patients in the LG demonstrated a significantly lower 3-year overall survival rate than those in the SG (p < 0.001). Additionally, in the LG, 3-year overall survival rates were similar among patients with different total numbers of areas with enlarged LNs. After matching, the 3-year overall survival rate of the LG was close to that of the SG (81.1% vs. 72.4%, p = 0.066). A stratified analysis according to the only independent prognostic factor (pTNM stage) demonstrated that the 3-year overall survival rates at each stage were similar between the LG and SG.

Conclusions: LAG has similar oncologic outcomes for GC with or without preoperative enlarged LNs in the same tumor stage. Furthermore, the total number of areas with enlarged LNs has no impact on the long-term outcome.