LONG-TERM RESULTS OF TREATMENT IN PATIENTS WITH GASTRIC CANCER REGARDING VOLUME OF LYMPHODISSECTION AND CHARACTERS OF NEOPLASTIC PROCESS

Gastric cancer keeps its position among the top five leaders of oncological mortality. Extended lymph node dissection D2 allows to achieve good long-term results after surgical treatment, however process extension and specific features of a tumor have significant impact on the result.

Background. Study influence of various tumor characteristics, volume of LN dissection and operation on recurrence probability in patients with locally-advanced gastric cancer.

Material and methods.We performed analysis of long-term results of treatment in 662 patients with gastric cancer with application of minimum admissible lymph node dissection D1 and extended lymphodissection D2 operated by one group of surgeons and also 10 various characteristics of tumor process which had an impact on survival rate.

Results. Improved survival in patients with extended LN dissection was observed beginning from stage II disease and was the best in cases with stage III. Main group of patients treated with extended LN dissection showed better results compring to the control group with minimally accepted lymphodissection regarding overall and recurrence-free lifespan. Own effect of an extended LN dissection is shown against the background of any other factor of variability. Effects of tumor characteristics (first of all, its prevalence, i.e. stage of disease, metastatic invasion of regional lymph nodes and histologic structure of tumor) and combined surgical volume have always more effect than extended LN dissection.

Conclusions.The observed additional effect of an extended lymph node dissection is universal, that is shown on any clinical background of the disease – histologic structure, gastric localization, form of tumor growth, invasion depth in a gastric wall, invasion of regional lymph nodes and stage of cancer (except stage I). The most significant negative impact on life expectancy in patients after treatment had low differentiated tumors, metastatic invasion of regional lymph nodes, stages of disease, on duration of recurrence-free period – stage of cancer and the combined nature of surgical intervention.

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