Brief Article
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World J Gastroenterol. Sep 21, 2011; 17(35): 4007-4012
Published online Sep 21, 2011. doi: 10.3748/wjg.v17.i35.4007
Does N ratio affect survival in D1 and D2 lymph node dissection for gastric cancer?
Ibrahim Sakcak, Barış Doğu Yıldız, Fatih Mehmet Avşar, Saadet Akturan, Kemal Kilic, Erdal Cosgun, Enver O Hamamci
Ibrahim Sakcak, Barış Doğu Yıldız, Enver O Hamamci, Department of 6th General Surgery, Numune Teaching and Research Hospital, 06100 Sihhiye, Ankara, Turkey
Fatih Mehmet Avşar, Department of 6th General Surgery, Numune Teaching and Research Hospital, 06100 Sihhiye, Ankara, Turkey
Fatih Mehmet Avşar, Kafkas University Faculty of Medicine, Chief of Surgery, 36000 Kars, Turkey
Saadet Akturan, Department of General Surgery, Etlik Teaching and Research Hospital, 06010 Ankara, Turkey
Kemal Kilic, Kafkas University Faculty of Medicine, General Surgery Department, 36000 Kars, Turkey
Erdal Cosgun, Department of Statistics, Hacettepe University Faculty of Medicine, 06100 Sihhiye, Ankara, Turkey
Author contributions: Sakcak I, Yildiz B, Kilic K, Cosgun E and Akturan S provided data and analytical tools and were also involved in editing the manuscript; Sakcak I and Avşar FM co-ordinated and provided the collection of all the human material in addition to providing financial support for this work; Sakcak I and Yıldız BD designed the study and wrote the manuscript. Hamamci EO provide to revising it critically for important intellectual content.
Correspondence to: Ibrahim Sakcak, MD, Cukurambar Mah. 42. Cad. Sancak Apt. No. 11/7, 06600 Cankaya, Ankara, Turkey.
Telephone: +90-312-5085252 Fax: +90-312-5085252
Received: December 29, 2010
Revised: March 2, 2011
Accepted: March 9, 2011
Published online: September 21, 2011

AIM: To identify whether there could have been changes in survival if lymph node ratio (N ratio) had been used.

METHODS: We assessed 334 gastric adenocarcinoma cases retrospectively between 2001 and 2009. Two hundred and sixteen patients out of 334 were included in the study. Patients were grouped according to disection1 (D1) or dissection 2 (D2) dissection. We compared the estimated survival and actual survival determined by Pathologic nodes (pN) class and N ratio, and SPSS 15.0 software was used for statistical analysis.

RESULTS: Ninety-six (44.4%) patients underwent D1 dissection and 120 (55.6%) had D2 dissection. When groups were evaluated, 23 (24.0%) patients in D1 and 21 (17.5%) in D2 had stage migration (P = 0.001). When both D1 and D2 groups were evaluated for number of pathological lymph nodes, despite the fact that there was no difference in N ratio between D1 and D2 groups, a statistically significant difference was found between them with regard to pN1 and pN2 groups (P = 0.047, P = 0.044 respectively). In D1, pN0 had the longest survival while pN3 had the shortest. In D2, pN0 had the longest survival whereas pN3 had the shortest survival.

CONCLUSION: N ratio is an accurate staging system for defining prognosis and treatment plan, thus decreasing methodological errors in gastric cancer staging.

Keywords: Gastric cancer, Lymph node dissection, Node ratio, Tumor nodule metastasis