Adequate lymphadenectomy results in accurate nodal staging without an increase in morbidity in patients with gastric adenocarcinoma

BackgroundProper resection in gastric cancer should include more than 15 lymph nodes for accurate staging. We sought to determine if adequate nodal dissection would result in more accurate N staging without an increase in mortality.MethodsData from a prospectively maintained (January 1996 to August 2006) foregut malignancy database were reviewed, and trends in treatment from 3 time periods (1996–1998, 1999–2001, and 2002–2006) were compared.ResultsThree hundred fifty-three patients treated had an average number of nodes examined of 13.1, with a significant increase in the number of nodes from years 1996 to 1998 (9.2), 1999 to 2001(10.2), and 2002 to 2005 (15.9) (P = .001). There was a significant decrease in 30-day (11.9% to 11.8% to 3.5%, P = .001) and 60-day mortality (15.2% to 18.6% to 10.6%, P = .001) during those same time periods.ConclusionsThrough an increase in multidisciplinary collaboration, the surgical standards in gastric cancers has improved, with greater lymph node evaluation, greater lymph node staging accuracy, and decreased overall mortality.