Prognosis of gastric cancer patients with paraaortic lymph node metastasis versus those with distant metastases

Introduction. It has long been thought that cases of advanced gastric cancer with paraaortic lymph node (PALN) metastasis are impossible to cure. However, several recent reports on the long-term survival of patients with PALN metastasis have reported an increase in the use of gastrectomy with extended lymphadenectomy, involving the dissection of more nodes than those invaded by the tumour, as the standard surgery for advanced gastric cancer.  Material and methods. The records of 1,015 patients with a confirmed histologic diagnosis of gastric cancer had been reviewed. Among patients with stage IV gastric cancer, 38 had PALN metastasis compared with 233 with peritoneal dissemination and 77 with hepatic metastasis.  Results. Based on tumour location, metastasis to the PALNs was more common in upper-third cancer (p < 0.01); hepatic metastasis was more common in well-differentiated adenocarcinoma, and peritoneal dissemination was more common in poorly differentiated cancer (p < 0.001). The 5-year survival in patients with metastasis to the PALNs was significantly higher (28.2%) than in patients with peritoneal dissemination (5.2%) or hepatic metastasis (12.0%) (p < 0.01).  Conclusions. The results reveal a better 5-year survival associated with gastric cancer patients with PALN metastasis as compared with those with other distant metastases. Therefore, performing a more extended lymphadenectomy in patients with gastric cancer is recommended, especially those with suspected metastasis to the PALNs.