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Appropriate Gastric Resection with Lymph Node Dissection for Early Gastric Cancer

From the Service Chirurgie Digestive A, Hôpital St Eloi (FB, NP, BM), Montpellier; Service de Chirurgie Digestive et Générale, Hôpital Louis Mourier (JMH), Colombes; and Service de Chirurgie Digestive et Générale, Hôpital Henri Mondor (PLF), Créteil, France.

Correspondence: Address correspondence and reprint requests to: Frédéric Borie, MD, Service de chirurgie Digestive A, Hopital St. Eloi, 80 avenue A. Fliche, 34295 Montpellier, France. Telephone: +33.(0)4.67.33.71.05, e-mail: fborie{at}yahoo.com

Background: The extent of lymphadenectomy (limited vs. extended) and that of gastric resection (partial vs. total) remain controversial issues in the management of early gastric cancer (EGC). A multicentric study was performed to elucidate the appropriate gastric resection with lymph node dissection for early gastric cancer.

Methods: From 1979 to 1988, 332 patients with EGC underwent surgery in 23 French centers. Clinicopathological data, the extent of resection, and the number of lymph nodes retrieved were reviewed retrospectively and screened for prognostic effect. The mean follow-up for the 332 EGC patients was 80 months.

Results: Postoperative mortality was correlated to age (odds ratio [OR], 1.1) and extent of gastric resection (OR,10.3). Examination of survival data (excluding postoperative deaths) with univariate analysis and the Cox proportional hazards model showed that the independent factors for excellent prognosis included no lymphatic involvement (P = .005), 10 or more lymph nodes retrieved (P = .003), site of the tumor in the lower third of the stomach (P = .01), and mucosal lesions (P = .04). The extent of resection did not influence long-term survival.

Conclusions: Our results suggest that because of the associated good prognosis, the appropriate surgical treatment for EGC is partial gastrectomy with lymphadenectomy retrieving 10 or more lymph nodes.

Key Words: Early gastric cancer • Lymph node • Surgery

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