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12.02.2019 | Gastrointestinal Oncology | Ausgabe 6/2019

Annals of Surgical Oncology 6/2019

Does Noncompliance in Lymph Node Dissection Affect Oncological Efficacy in Gastric Cancer Patients Undergoing Radical Gastrectomy?

Annals of Surgical Oncology > Ausgabe 6/2019
MD Qi-Yue Chen, MD Qing Zhong, MD Zhi-Yu Liu, PhD Jian-Wei Xie, PhD Jia-Bin Wang, MD Jian-Xian Lin, MD Jun Lu, MD Long-Long Cao, MD Mi Lin, MD Ru-Hong Tu, MD Ze-Ning Huang, MD Ju-Li Lin, PhD Ping Li, PhD Chao-Hui Zheng, MD Chang-Ming Huang
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1245/​s10434-019-07217-x) contains supplementary material, which is available to authorized users.
Qi-Yue Chen and Qing Zhong have contributed equally to this work and should be considered co-first authors.

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Few reports have examined the prognosis of or possible remedial treatments for patients with noncompliant D2 lymphadenectomy. We investigated the effect of noncompliance in lymph node (LN) dissection on long-term survival in gastric cancer (GC) patients after radical gastrectomy and explored intervention measures.


Clinicopathological data were retrospectively analyzed in 2401 patients who underwent radical gastrectomy for GC. Noncompliance was defined as patients with more than one empty LN station, as described in the protocol of the Japanese GC Association.


The overall noncompliance rate was 49.1%. The 3-year overall survival (OS) rate was significantly better in compliant than noncompliant patients (74.0% vs. 60.1%, P < 0.001). Univariate and multivariate analyses revealed that noncompliance was an independent risk factor for OS. Logistic regression analysis demonstrated that extent of gastrectomy, primary tumor site, history of intraperitoneal surgery, body mass index, and open gastrectomy were independent preoperative predictive factors for noncompliance. Cox analysis demonstrated that age, pT, pN, and extent of gastrectomy independently affected OS in patients with noncompliant lymphadenectomy. However, OS was significantly better in the compliant than noncompliant group regardless of the recommendation for chemotherapy. Stratified analysis demonstrated that OS was significantly better in chemotherapy patients than in patients without chemotherapy and stage II patients (pT1N2/N3M0 and pT3N0M0) in whom chemotherapy was not recommended.


Noncompliance is an independent risk factor after radical gastrectomy for GC. Adjuvant chemotherapy improved the prognosis of patients with pT1N2/N3M0 and pT3N0M0 disease who underwent noncompliant D2 lymphadenectomy.

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