Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologically-positive Para-aortic Lymph Nodes

Background: The role of para-aortic lymph node (PALN) dissection for far-advanced gastric cancer is controversial in patients with clinical PALN positivity who have responded to chemotherapy. Materials and Methods: We retrospectively analyzed long-term outcomes of patients with pathologically-positive PALNs who underwent radical gastrectomy. Results: The 3- and 5-year overall survival (OS) rates of 65 pathologically PALN-positive patients who underwent PALN dissection (n=704) were 33.8% and 21.2%, respectively. Multivariable analysis revealed the following poor prognostic factors: nodal involvement around the celiac axis (hazard ratio (HR)=4.04, 95% confidence interval (CI)=1.55-9.63), tumor diameter of >= 120 mm (HR=3.37; 95% CI=1.189.63) and >= 3 PALNs involved (HR=2.24; 95% CI=1.21-4.15). Patients with none of these factors survived significantly longer than those with any of these factors (5-year OS=87.5% versus 9.3%, respectively; p<0.001). Conclusion: Pathologically PALN-positive patients achieve long survival; however, the indications for PALN dissection should be carefully considered.