Paraaortic lymphadenectomy in patients with advanced carcinoma of the upper-third of the stomach.

BACKGROUND/AIMS: According to current TNM classification, paraaortic nodes involvement in gastric cancer is now distant metastasis. Anatomically, however, proximal gastric cancer may drain preferentially to the left-paraaortic area which represents a regional lymph-node basin.

METHODOLOGY: Seventy-five patients who underwent an extended gastrectomy with paraaortic lymphadenectomy for advanced carcinoma of the upper-third of the stomach were retrospectively studied.

RESULTS: Of the 75 patients, 55 (73.3%) were positive for nodal metastasis and 21 (28.0%) had paraaortic nodes involvement. Paraaortic nodes involvement tended to be left-sided (the left side of the aorta around the left renal vein) and its incidence did not increase as the overall number of infiltrated nodes increased. Five (23.8%) of the 21 patients with paraaortic nodes involvement did not have nodal metastases in the paraceliac area. Overall survival was not different whether or not paraaortic nodes involvement was present, but was dependent on the overall number of infiltrated nodes (viz. 10 vs. > 10). Eight (22.2%) of 36 patients with 1-10 infiltrated nodes had PNI, with a 5-year survival rate of 46.9%.

CONCLUSIONS: Removal of lymph nodes around the left renal vein should be included during extended gastrectomy in patients with advanced carcinoma of the upper-third of the stomach. Left-paraaortic lymphadenectomy may benefit such patients if the overall number of infiltrated nodes is low (viz. 10).