Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial

Sep 28, 2026

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Study evaluates three-year outcomes and lymph node metastasis distribution in advanced gastric cancer treated with neoadjuvant chemotherapy, comparing open total gastrectomy (OTG) with minimally invasive total gastrectomy (MITG). Using a retrospective analysis of the European STOMACH randomized trial across thirteen hospitals, investigators examine lymphadenectomy completeness, number of resected nodes, and metastatic patterns. Results show no difference in 3-year survival, while tier-2 node metastases differ significantly and pathologist-reported D2 adherence is low.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Abstract

Background

Methods

Results

Conclusion

Methods

Trial design and ethics

Surgical Endoscopy (2023) 37:7317–7324 [https://doi.org/10.1007/s00464-023-10278-5](https://doi.org/10.1007/s00464-023-10278-5) and Other Interventional Techniques Three‑year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial Nicole van der Wielen1,16 · Freek Daams1,16 · Riccardo Rosati3 · Paolo Parise3 · Jürgen Weitz4 · Christoph Reissfelder5 · Ismael Diez del Val6 · Carlos Loureiro6 · Purificación Parada‑González7 · Elena Pintos‑Martínez7 · Francisco Mateo Vallejo8 · Carlos Medina Achirica8 · Andrés Sánchez‑Pernaute9 · Adriana Ruano Campos9 · Luigi Bonavina10 · Emanuele L. G. Asti10 · Alfredo Alonso Poza11 · Carlos Gilsanz11 · Magnus Nilsson12 · Mats Lindblad12 · Suzanne S. Gisbertz13,16 · Mark I. van Berge Henegouwen13,16 · Uberto Fumagalli Romario14 · Stefano De Pascale14 · Khurshid Akhtar15 · Miguel A. Cuesta1 · Donald L. van der Peet1,16 · Jennifer Straatman1,2,16 Received: 31 March 2023 / Accepted: 2 July 2023 / Published online: 19 July 2023 © The Author(s) 2023 Abstract Background Adequate lymphadenectomy is an important step in gastrectomy for cancer, with a modified D2 lymphadenectomy being recommended for advanced gastric cancers. When assessing a novel technique for the treatment of gastric cancer, lymphadenectomy should be non-inferior. The aim of this study was to assess completeness of lymphadenectomy and distribution patterns between open total gastrectomy (OTG) and minimally invasive total gastrectomy (MITG) in the era of peri-operative chemotherapy. Methods This is a retrospective analysis of the STOMACH trial, a randomized clinical trial in thirteen hospitals in Europe. Patients were randomized between OTG and MITG for advanced gastric cancer after neoadjuvant chemotherapy. Three-year survival, number of resected lymph nodes, completeness of lymphadenectomy, and distribution patterns were examined. Results A total of 96 patients were included in this trial and randomized between OTG (49 patients) and MITG (47 patients) . No difference in 3-year survival was observed, this was 57.1% in OTG group versus 46.8% in MITG group (P = 0.186) . The mean number of examined lymph nodes per patient was 44.3 ± 16.7 in the OTG group and 40.7 ± 16.3 in the MITG group (P = 0.209). D2 lymphadenectomy of 71.4% in the OTG group and 74.5% in the MITG group was performed according to the surgeons; according to the pathologist compliance to D2 lymphadenectomy was 30% in the OTG group and 36% in the MITG group. Tier 2 lymph node metastases (stations 7–12) were observed in 19.6% in the OTG group versus 43.5% in the MITG group (P = 0.024) . Conclusion No difference in 3-year survival was observed between open and minimally invasive gastrectomy. No differences were observed for lymph node yield and type of lymphadenectomy. Adherence to D2 lymphadenectomy reported by the pathologist was markedly low. Keywords Survival · Lymph node distribution · Minimally invasive gastrectomy Adequate resection with lymphadenectomy remains the core of curative treatment for patients with advanced gastric cancer in the era of peri-operative chemotherapy. In total gastrectomy, the Japanese Gastric Cancer Association (JGCA) guidelines recommend radical resection with adequatelymphadenectomy, consisting of a modified D2 lymph node Extended author information available on the last page of the article dissection with a minimum of 15 lymph nodes. Taking into consideration that D2 lymphadenectomy leads to superior outcomes in survival in comparison to D1 resection [1] . D1 nodes include the tier one nodes: around the crus, in the lesser omentum, and around the gastro-epiploic artery and supra-and infrapyloric nodes. D2 includes the additional removal of tier two nodes: along the celiac trunk, left gastric artery, common hepatic artery, hepatic proper artery, and splenic artery [2] . In line with the Japanese Classification of

FAQs

How was lymphadenectomy completeness evaluated in the study?

Completeness of lymphadenectomy and distribution patterns were assessed by examining lymph node yield and metastatic distribution between OTG and MITG after neoadjuvant chemotherapy.

What did the trial find about three-year survival between OTG and MITG?

No difference in 3-year survival was observed: 57.1% in the OTG group versus 46.8% in the MITG group (P = 0.186).

Which lymph node metastasis levels differed between the two surgical approaches?

Tier 2 lymph node metastases (stations 7–12) were more frequent in the MITG group (43.5%) than in the OTG group (19.6%), with P = 0.024.

Sep 28, 2026

Uploaded by Aditya