Survival benefits of pancreatoduodenectomy for gastric cancer: relationship to the number of lymph node metastases

Background and aims Pancreatoduodenectomy (PD) for advanced gastric cancer is rarely performed because of the high frequency of associated morbidity and mortality. The aim of this study was to determine the limited indication of PD for advanced gastric cancer. Materials and methods From January 1984 and December 2005 patient's charts were reviewed and outcomes after PD for gastric cancer were compared between two subgroups; those with a 'high' number (7 <= group) of lymph node metastases and those with 'low' numbers (6 >= group). Results PD was intraoperatively selected because of direct tumor invasion into the pancreas (52.2% of the 7 <= group vs 12.5% of the 6 >= group) or pancreatic lymph node infiltration (47.8% of the 7 <= group vs 87.5% of the 6 >= group; P = 0.058). The postoperative histological analysis showed 22 cases from 23 (95.7%) in 7 <= group with T3 or T4 tumor, compared with only 4 cases (50%) in 6 >= group (P = 0.014). The 5-year survival rates were significantly better in the 6 >= group compared with the 7 <= group (P = 0.014). Conclusions The indication for PD in advanced gastric cancer should consider the degree of extensive lymph node metastases and incurable factors.