The value of N staging with the positive lymph node ratio, and splenectomy, for remnant gastric cancer: A multicenter retrospective study

BackgroundSurgery for remnant gastric cancer (RGC) frequently fails to obtain the >15 lymph nodes necessary for tumor-node-metastasis (TNM) staging. We aimed to evaluate the utility of the recently developed tumor-ratio-metastasis (TRM) staging system. We also examined the pattern of lymph node metastasis and the role of prophylactic splenectomy in RGC. MethodsBetween May 2003 and December 2012, data from 170 patients who underwent surgery for RGC were retrospectively analyzed. ResultsRGC arising after previous benign disease (n=46) was associated with retrieval of more lymph nodes (27.3 vs 10.0; P<0.001), and a lower rate of retrieving 15 lymph nodes (15.6% vs 77.4%, P<0.001), than after previous malignant disease (n=122). The 5 year survival rate according to TNM staging was 75% in stage I, 77.1% in stage II, and 23.5% in stage III, whereas by TRM staging it was 75%, 81.6%, and 23.2%, respectively. Overall survival was not different between the splenectomy and non-splenectomy groups at each stage (P=0.751, 0.723, 0.151, and 0.706 for stage I, II, III, and IV, respectively). ConclusionThe analyses did not identify a survival benefit from prophylactic splenectomy or show an improvement in staging with the TRM system for RGC.