Optimal extent of lymph node dissection for high‐risk gastric cancer stratified by a national clinical database risk calculator

Abstract

AbstractBackgroundFor patients with gastric cancer, a well‐balanced treatment that considers both oncological aspects and surgical risk is demanded. This study aimed to explore the optimal extent of lymph node dissection (LND) for patients with gastric cancer according to surgical risk, stratified by the risk calculator system produced by the Japan National Clinical Database (NCD).Patients and MethodsWe retrospectively evaluated 187 patients who underwent radical gastrectomy for gastric cancer. Using the median predicted anastomotic leak rate obtained by the NCD risk calculator as the cutoff value, we classified 97 and 90 patients as having high and low risks, respectively.ResultsIn low‐risk patients, although limited LND reduced the postoperative intraabdominal infectious complications (IAIC), multivariate analysis revealed standard LND as an independent prognostic factor that improved Relapse‐free survival (RFS). In high‐risk patients, the rates of postoperative IAIC and RFS were similar between standard and limited LND. Pancreatic fistula was not observed in the limited dissection group.ConclusionLimited LND might be the optimal treatment strategy for patients with gastric cancer with high surgical risk.