Impact of the Number of Harvested Lymph Nodes on the Survival of Egyptian Patients with Gastric Cancer: Middle Eastern Tertiary Center Experience

Background: In the present research, we aimed to estimate the effect of the number of resected lymph nodes (LN) on the survival outcomes of patients with resectable gastric cancer; we investigated whether 16 LNs remained the optimal threshold and whether a specific subset of patients could benefit from further LN dissected. Method: This cohort study included consecutive patients who underwent surgical resection for gastric cancers from the start of 2012 to the end of 2014. Demographic, clinic-pathologic, laboratory data (including complete blood picture, renal function tests, liver function tests, C-reactive protein, Prothrombin profile, and electrolytes), type of surgery, systemic chemotherapy, treatment, and survival data were retrospectively collected from the patients' files. Results: The mean overall survival +/- standard error (SE) was 23.051 +/- 2.249 months with 95% confidence interval (CI) = 18.644-27.459, while the mean diseasefree survival +/- SE was 20.675 +/- 2.414 months with 95% CI = 15.944-25.906. D2 dissection was associated with significantly better OS and disease-free survival (P = 0.001 and P = 0.001, respectively). The mean OS for the patients with <16 lymph node dissected was 13.480 +/- 1.468 with 95% CI = 10.603-16.357; whereas for those patients with <16 lymph nodes dissected, it was 20.738 +/- 2.065 with 95% CI = 16.690-24.786 months, log-rank = 8.030 (P = 0.005). Conclusion: The benefit of D2 lymphadenectomy, and subsequently dissecting more LNs, still remains under question; however, if morbidity and mortality are kept at a minimum level, D2 dissection could be advantageous. Our study concluded that harvesting further LNs was associated with more survival benefit.