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Tumor Site and Perigastric Nodal Status are the Most Important Predictors of Para-Aortic Nodal Involvement in Advanced Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study was designed to identify pathological predictors of para-aortic nodal invasion in advanced gastric cancer.

Methods

Between 1990 and 2007, 294 patients with advanced gastric cancer underwent gastrectomy with D2 lymphadenectomy + para-aortic nodal dissection in Siena and Verona, Italy.

Results

Forty-seven (16%) patients had para-aortic node metastases. Of these, 91%, 88%, and 74%, respectively, also had metastases at stations No. 3, No. 1, and No. 7. Para-aortic node metastases were never observed when stations No. 1 and No. 3 were both negative. Patients were divided into three groups, according to the risk of para-aortic node invasion: (1) high-risk group (n = 24, 8.2%), presenting a 42% risk and comprising T3/T4 cancers with mixed/nonintestinal histology, arising from the upper third; (2) low-risk group (n = 138, 46.9%), presenting a 0–10% risk and including middle-lower third tumors—either T2 irrespective of histology, or T3/T4 with intestinal histology; (3) intermediate-risk group, comprising all other patients (n = 132, 44.9%). Their risk ranged between 16% and 30%, but increased up to 21–37.5% after excluding 33 patients with negative No. 1 and No. 3 stations.

Conclusions

The combination of tumor site, histology, and T stage with perigastric nodal status allowed identification of patients at higher risk of para-aortic nodal invasion who could benefit from para-aortic nodal dissection.

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Conflicts of Interest

All of the authors declare that they have no potential commercial conflicts of interest relevant to this article.

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Authors and Affiliations

  1. First Division of General Surgery, University of Verona, Verona, Italy

    Giovanni de Manzoni MD, Simone Giacopuzzi MD & Anna Maria Minicozzi MD

  2. Unit of General Surgery, Arco Hospital, APSS of Trento, Trento, Italy

    Alberto Di Leo MD

  3. Division of Surgical Oncology, University of Siena, Siena, Italy

    Franco Roviello MD & Daniele Marrelli MD

  4. Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy

    Giuseppe Verlato MD

Authors
  1. Giovanni de Manzoni MD
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  2. Alberto Di Leo MD
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  3. Franco Roviello MD
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  4. Daniele Marrelli MD
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  5. Simone Giacopuzzi MD
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  6. Anna Maria Minicozzi MD
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  7. Giuseppe Verlato MD
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Corresponding author

Correspondence to Giovanni de Manzoni MD.

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de Manzoni, G., Di Leo, A., Roviello, F. et al. Tumor Site and Perigastric Nodal Status are the Most Important Predictors of Para-Aortic Nodal Involvement in Advanced Gastric Cancer. Ann Surg Oncol 18, 2273–2280 (2011). https://doi.org/10.1245/s10434-010-1547-5

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  • DOI: https://doi.org/10.1245/s10434-010-1547-5

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