How Should We Measure the Quality of Lymphadenectomy for Gastric Cancer? Anatomical Versus Numerical Criterion



To compare anatomical with numerical criterion to measure the quality of lymphadenectomy for gastric cancer.

Patients and Methods

We analyzed 447 gastric cancer patients with resectable tumor stage (R0 resection) with at least 16 examined lymph nodes.


Of 447 patients, 82.6% underwent D2 lymphadenectomy for a median of total examined lymph nodes of 28. The 7-year disease-specific survival rate for the whole sample was 71.4%. Survival was significantly different between patients treated with D2 and D1 lymphadenectomy (77.4% versus 44.3%; p < 0.001) and between patients with total examined lymph nodes ≥ 28 and < 28 (74.5% versus 62.3%; p = 0.041). Anatomical criterion significantly differentiated 7-year survival in patients stratified according to a numerical parameter.


We should still consider the anatomical criterion as the best item to measure the quality of lymphadenectomy for gastric cancer.

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Correspondence to Georgios Lianos.

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• There is no reliable criteria to evaluate the quality of lymphadenectomy for gastric cancer.

• In this multicenter study, we analyzed a large cohort of selected gastric cancer patients to compare anatomical with numerical criterion to measure the quality of the lymphadenectomy.

• Seven-year survival was significantly different between patients treated with D2 and D1 lymphadenectomy and between patients with ≥ 28 and < 28 total examined lymph nodes, but the anatomical criterion was more effective to significantly differentiated patients survival.

• Numerical criterion is too variable to be considered reliable in the evaluating (in a “post hoc” phase) the quality of lymphadenectomy.

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Rausei, S., Galli, F., Lianos, G. et al. How Should We Measure the Quality of Lymphadenectomy for Gastric Cancer? Anatomical Versus Numerical Criterion. J Gastrointest Canc 51, 887–892 (2020).

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  • Locally advanced gastric cancer
  • Lymphadenectomy
  • Number of removed lymph nodes
  • Cancer-related survival