Posted online on April 12, 2004 on www.jco.org [1]Read the Study [2]A new study has shown that extended lymph node dissection - a treatment for stomach cancer that involves the surgical removal of lymph nodes near the tumor, in distant areas of the stomach, and in some cases, in combination with the removal of the spleen and part of the pancreas - has shown no long-term survival benefit for stomach cancer patients.Stomach cancer is the fourth most common type of cancer worldwide, and is diagnosed in approximately 870,000 people annually. While the rate of stomach cancer is declining, it remains an important cause of death worldwide. Surgery is the only possible curative treatment, and results of gastrectomy - the removal of part or all of the stomach - have improved significantly over the years in terms of lengthening patients' lives.However, researchers have long debated whether extended lymph node dissection, one type of gastrectomy, has contributed to patients living longer.To answer this question, researchers at the Leiden University Medical Center in The Netherlands compared extended lymph node dissection to limited lymph node dissection, a less extensive procedure in which only the tumor and surrounding lymph nodes are removed, to determine whether the widespread removal of lymph nodes in the stomach extended patients' lives.A total of 711 patients were treated, and researchers followed up after 11 years. Researchers found that 10% of the patients who underwent extended lymph node dissection died within 30 days of surgery, compared to 4% of patients who underwent limited lymph node dissection.Similarly, complications associated with the surgery were greater among patients who had extended lymph node dissection. Forty-three percent of patients who had extended surgery experienced complications, compared to 25% of patients in the limited group.Researchers concluded that extended lymph node dissection does not extend patients' lives, noting that the complications that result from surgery may offset any long-term survival benefit.What Does This Mean For Patients?Stomach cancer patients should talk with their doctors about treatment options—including both limited and extended lymph node dissection.For most patients, limited lymph node dissection is the most appropriate treatment, and patients should discuss with their doctors the potential risk and benefits of the procedure.However, in a small number of patients, extended lymph node dissection may extend survival. Doctors should avoid removing the spleen and the pancreas, which can cause complications following surgery.