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In Japan, cancer of the stomach is more common and the cure rate after surgery is better than in the United States. Because of this discrepancy, the American College of Surgeons Commission and the American Cancer Society reviewed the cases of 50,169 persons who received surgical treatment for stomach cancer to determine which treatment factors might be associated with higher cure rates. The findings? It appears that the removal of more lymph nodes and the overall quality of the surgery performed may be associated with improvements in survival.

Persons who have cancer of the stomach are frequently treated with surgical removal of the stomach (called a

gastrectomy), to control the cancer and prevent recurrence (or return) of the cancer.

Lymph nodes (parts of the body’s

lymph system) around the stomach are also removed and examined to determine whether or not the cancer has spread to these areas. Depending on the stage (extent of disease at diagnosis) of the cancer, treatment with chemotherapy drugs after surgery (called

adjuvant chemotherapy) may also be an option; however, there is some controversy about whether this additional therapy provides any benefit. Other considerations include how many lymph nodes to remove and whether to remove other parts of the digestive and lymph systems, such as the spleen and pancreas.

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Researchers sought to answer address these issues by evaluating the cases of 50,169 patients who were treated from 1985 to 1996 with surgical gastrectomy for stage IA to IV cancers of the stomach. Overall, individuals with stage IA stomach cancer had a 78% 5-year survival rate and a 65% 10-year survival rate. Those with stage IB had 5- and 10-year survival rates of 58% and 42%; those with stage II, 34% and 26%; those with stage IIIA, 20% and 14%; those with stage IIIB, 8% and 3%; and persons with stage IV, 7% and 5% 5- and 10-year survival rates.

The results of the evaluation revealed that persons with cancers of the lower stomach had better outcomes than those with cancers of the upper stomach. Another factor that seemed to affect survival was whether the cancer had spread to the lymph nodes at the time of the surgery, with only 2% of persons having more than 8 lymph nodes affected with cancer surviving 10 years. Furthermore, persons with the same stage of cancer who had 15 or more lymph nodes removed during the surgery had a better survival time than did those who had fewer lymph nodes removed. These findings suggest that survival increases with the number of lymph nodes that are removed, and that some patients with stomach cancer in the United States may be receiving inadequate surgery. The use of treatment after surgery, such as chemotherapy, had no effect on survival.

These findings highlight the importance of lymph node removal in patients who undergo gastrectomy for stomach cancer. Although recommendations are for surgeons to remove at least 15 lymph nodes during surgery, less than half the patients evaluated had this many removed. The researchers concluded that the quality of surgery must be improved for persons having gastrectomy for stomach cancer. They suggest that persons about to undergo this procedure seek a treatment center in which large numbers of gastrectomies are performed each year and that they speak with their doctor about the potential advantages of having the maximum number of lymph nodes removed, without damage to other normal structures, such as the spleen and pancreas. Persons who have stomach cancer may wish to talk with their doctor about the risks and benefits of gastrectomy and removal of numerous lymph nodes, or of participating in a clinical trial in which new treatments are being studied. Sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute ( and the Clinical Trials section and service offered by Cancer ( (

Cancer, Vol 88, No 4, pp 921-932, 2000)

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