Impact of the Number of Harvested Lymph Nodes on the Survival of Egyptian Patients with Gastric Cancer: Middle Eastern Tertiary Center Experience

In the present research, we aimed to estimate the effect of the number of resected lymph nodes (LN) on the survival outcomes of patients with resectable gastric cancer; we investigated whether 16 LNs remained the optimal threshold and whether a specific subset of patients could benefit from further LN dissected.
This cohort study included consecutive patients who underwent surgical resection for gastric cancers from the start of 2012 to the end of 2014. Demographic, clinic-pathologic, laboratory data (including complete blood picture, renal function tests, liver function tests, C-reactive protein, Prothrombin profile, and electrolytes), type of surgery, systemic chemotherapy, treatment, and survival data were retrospectively collected from the patients' files.
The mean overall survival ± standard error (SE) was 23.051 ± 2.249 months with 95% confidence interval (CI) = 18.644-27.459, while the mean disease-free survival ± SE was 20.675 ± 2.414 months with 95% CI = 15.944-25.906. D2 dissection was associated with significantly better OS and disease-free survival (P = 0.001 and P = 0.001, respectively). The mean OS for the patients with <16 lymph node dissected was 13.480 ± 1.468 with 95% CI = 10.603-16.357; whereas for those patients with <16 lymph nodes dissected, it was 20.738 ± 2.065 with 95% CI = 16.690-24.786 months, log-rank = 8.030 (P = 0.005).
The benefit of D2 lymphadenectomy, and subsequently dissecting more LNs, still remains under question; however, if morbidity and mortality are kept at a minimum level, D2 dissection could be advantageous. Our study concluded that harvesting further LNs was associated with more survival benefit.