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10.1245/s10434-006-9002-3
Annals of Surgical Oncology 13:1163-1167 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Candidates for Curative Resection in Advanced Gastric Cancer Patients Who Had Equivocal Para-aortic Lymph Node Metastasis on Computed Tomographic Scan

Jun Ho Lee, MD, Yong Hae Paik, MD, Jong Seok Lee, MD, Ho Joon Song, MD, PhD, Keun Won Ryu, MD, PhD, Chan Gyoo Kim, MD, Sook Ryeon Park, MD, Myoung Cheorl Kook, MD, PhD, Young Woo Kim, MD, PhD and Jae-Moon Bae, MD, PhD

Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do411-769, Korea

Correspondence: Address correspondence and reprint requests to: Jae-Moon Bae, MD, PhD; E-mail: jmoonbae{at}ncc.re.kr.

Background: The aim of this study was to determine how to select potential candidates for curative resection among advanced gastric patients with equivocal findings of para-aortic lymph node metastasis on computed tomography (CT).

Methods: We analyzed the clinicopathologic results of 23 advanced gastric cancer patients who were diagnosed as having equivocal findings of para-aortic lymph node metastasis on a CT scan and who underwent gastrectomy with D2 and para-aortic lymph node dissection.

Results: Twenty-two patients were male, and one patient was female. The median age of all study subjects was 52 years (range, 31–75 years). Sixteen underwent total gastrectomy, and seven underwent subtotal gastrectomy. The median number of A2 (suprarenal) lymph nodes harvested was 2 (range, 1–5), and that of B1 (infrarenal) lymph nodes was 6 (range, 1–17). Ten (43.5%) of the 23 patients were proven pathologically to have metastasis to para-aortic lymph nodes. Two patients with cT2 cancer had no metastatic para-aortic lymph node, whereas three patients with cT4 disease had metastatic para-aortic lymph nodes (P = .021). Seven (70.0%) of 10 patients with pathologic para-aortic lymph node metastasis experienced recurrence, whereas only 2 (15.4%) of 13 patients without experienced recurrence (P = .008). The Lauren classification was found to be an independent predictor of para-aortic lymph node metastasis (relative risk; .13; 95% confidence interval, .02–.83; P = .03).

Conclusions: More than half of gastric cancer patients with equivocal findings of para-aortic lymph node metastasis on CT are potential candidates for curative resection. The Lauren classification of gastric cancer in patients with equivocal CT findings of para-aortic lymph node metastasis would be helpful when deciding on clinical stage and treatment plans in these patients.

Key Words: Gastric cancer • Para-aortic lymph node • Metastasis • Computed tomographic scan






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