Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial

Nicole van der Wielen, Freek Daams, Riccardo Rosati, Paolo Parise, J. rgen Weitz, Christoph Reissfelder, Ismael Diez del Val, Carlos Loureiro, Purificación Parada-González, Elena Pintos-Martínez, Francisco Mateo Vallejo, Carlos Medina Achirica, Andrés Sánchez-Pernaute, Adriana Ruano Campos, Luigi Bonavina, Emanuele L. G. Asti, Alfredo Alonso Poza, Carlos Gilsanz, Magnus Nilsson, Mats LindbladSuzanne S. Gisbertz, Mark I. van Berge Henegouwen, Uberto Fumagalli Romario, Stefano de Pascale, Khurshid Akhtar, Miguel A. Cuesta, Donald L. van der Peet, Jennifer Straatman

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)

Abstract

Background: Adequate lymphadenectomy is an important step in gastrectomy for cancer, with a modified D2 lymphadenectomy being recommended for advanced gastric cancers. When assessing a novel technique for the treatment of gastric cancer, lymphadenectomy should be non-inferior. The aim of this study was to assess completeness of lymphadenectomy and distribution patterns between open total gastrectomy (OTG) and minimally invasive total gastrectomy (MITG) in the era of peri-operative chemotherapy. Methods: This is a retrospective analysis of the STOMACH trial, a randomized clinical trial in thirteen hospitals in Europe. Patients were randomized between OTG and MITG for advanced gastric cancer after neoadjuvant chemotherapy. Three-year survival, number of resected lymph nodes, completeness of lymphadenectomy, and distribution patterns were examined. Results: A total of 96 patients were included in this trial and randomized between OTG (49 patients) and MITG (47 patients). No difference in 3-year survival was observed, this was 57.1% in OTG group versus 46.8% in MITG group (P = 0.186). The mean number of examined lymph nodes per patient was 44.3 ± 16.7 in the OTG group and 40.7 ± 16.3 in the MITG group (P = 0.209). D2 lymphadenectomy of 71.4% in the OTG group and 74.5% in the MITG group was performed according to the surgeons; according to the pathologist compliance to D2 lymphadenectomy was 30% in the OTG group and 36% in the MITG group. Tier 2 lymph node metastases (stations 7–12) were observed in 19.6% in the OTG group versus 43.5% in the MITG group (P = 0.024). Conclusion: No difference in 3-year survival was observed between open and minimally invasive gastrectomy. No differences were observed for lymph node yield and type of lymphadenectomy. Adherence to D2 lymphadenectomy reported by the pathologist was markedly low.
Original languageEnglish
Pages (from-to)7317-7324
Number of pages8
JournalSurgical endoscopy
Volume37
Issue number9
Early online date2023
DOIs
Publication statusPublished - Sept 2023

Keywords

  • Lymph node distribution
  • Minimally invasive gastrectomy
  • Survival

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