Radical surgery (R2 resection) for gastric cancer. A multivariate analysis.

Background: Extended lymphadenectomy remains controversial in the Western world. Its evaluation and the identification of high-risk patients after surgery are important tasks.

Methods: A retrospective prognostic study of 318 patients treated for potential cure of gastric cancer was performed. All patients underwent extended lymphadenectomy. Clinical histopathologic and surgical factors were examined for their influence on survival by univariate and multivariate analysis.

Results: Postoperative mortality was 4.4% (14 of 318), and the 5-year adjusted survival rate was 57.8%. Multivariate analysis using the Cox model identified seven factors as having independent influence on survival. Detrimental factors were male gender, age over 65 years, high pN category, increasing number of lymph nodes invaded by metastases, total gastric resection, splenectomy, and increasing number of perioperatively required blood units.

Conclusion: Extended lymphadenectomy was possible without sacrificing low postoperative mortality rates. The importance of certain prognostic factors, in particular lymph node status, could be confirmed.