According to a recent article published in the journal Surgery, the removal of at least 15 lymph nodes during surgery appears to improve duration of survival for patients with stage III gastric cancer.

  1. Cancer of the stomach is characterized by the presence of cancer cells in the tissues of the stomach, which is located in the upper abdomen. The stomach is the primary organ of digestion. Food passes through the esophagus into the stomach at the level of the diaphragm, which is the breathing muscle that separates the abdomen from the chest. The stomach extends from the diaphragm to the duodenum, which is the first portion of the small intestine. Stage III gastric cancer refers to cancer that has spread locally outside the stomach, but not to distant sites in the body. The surgical removal of the cancer with or without chemotherapy or radiation is commonly used to treat patients with gastric cancer. Surgeons try to remove all visible cancer during surgery, as well as regional lymph nodes. However, the optimal number of lymph nodes to surgically remove has not yet been established.

Researchers from Rush Medical College and Stroger Hospital in Chicago recently reviewed published literature involving patients with gastric cancer undergoing surgery. The review included 147 patients who underwent the removal of their stomach (gastrectomy) and surrounding lymph nodes between 1992 and 2001. Patients were divided into two different groups: those who had 15 or fewer lymph nodes removed and those who had greater than 15 lymph nodes removed. Patients in the two groups were matched so that they had similar age, gender and cancer location. However, the group of patients who had 15 or more lymph nodes removed tended to have more advanced cancer. The average duration of survival for patients with stage III gastric cancer was over double in the group that had 15 or more lymph nodes removed (nearly 34 months), compared to those with 15 or fewer removed (14.4 months). Surgery-related complications were not increased in the group of patients who had more lymph nodes removed. These results are consistent with a previous study indicating that the removal of 15 or more regional lymph nodes appears to improve survival in patients with gastric cancer.

  1. The researchers suggest that patients with stage III gastric cancer who are undergoing a gastrectomy should have at least 15 lymph nodes removed, as this appears to be associated with a significant improvement in survival. Patients with stage III gastric cancer who are to undergo a gastrectomy may wish to speak with their physician about the risks and benefits of having at least 15 lymph nodes removed during the surgical procedure.

References:

1.Liu K, Loewen M, Atten M, et al. The survival of stage III gastric cancer patients is affected by the number of lymph nodes removed. Surgery. 2003;134:639-646.

  1. Cancer. 2000;88:4. pp 921-932.