80 Background: While a minimum of 15 lymphnodes (LNs) should be evaluated for accurate staging of gastric cancer, LN yield in western countries is generally low. With the increasing use of preoperative chemotherapy, it is unknown what the effect of this treatment is on lymph node yield. The aim of the study is therefore to determine whether preoperative chemotherapy influences the number of LNs that can be obtained from specimens of patients who underwent curative surgery for gastric adenocarcinoma. Methods: In1,205 patients from a high-volume U.S. center and 1,220 patients from the Netherlands Cancer Registry (NCR) who underwent a total or distal gastrectomy with curative intent for gastric adenocarcinoma, the LN yield was compared between patients who received preoperative chemotherapy and patients who received no neoadjuvant therapy. Multivariate Poisson regression was used to identify significant predictors of LN retrieval. Results: Of the 2,425 patients who underwent a gastrectomy, 340 patients (14%) received preoperative chemotherapy. Median LN yields were 23 in the U.S. institution and 10 in the NCR. Separate multivariate analyses of the U.S. institution data and the NCR population showed in both groups that preoperative chemotherapy was not associated with a significant difference in LN yield (Table). Factors that were associated with higher LN yield were the same in both groups: female sex, younger age (6% more nodes with every 10 years decrease in age), total gastrectomy (vs. distal gastrectomy) and increasing tumor (T) stage. Conclusions: In both a high-volume cancer center, and a population-based cancer registry, female sex, younger age, total gastrectomy and advanced tumor stage were associated with an increase in lymph node retrieval in surgical specimens. Preoperative chemotherapy did not influence lymph node yield after a resection for gastric cancer. The threshold for what should constitute an adequate assessment of regional lymph nodes after curative surgery for gastric cancer should not be changed after administration of preoperative chemotherapy. [Table: see text] No significant financial relationships to disclose.
Pylorus preserving versus classic pancreaticoduodenectomy: a single center retrospective review of total lymph node yield
