LAUSR

The NCCN guidelines acknowledge that while there is no universally accepted minimum number of lymph nodes (LNs) necessary for accurate staging of gastric cancer, retrieval of at least 15 LNs is recommended to avoid stage migration. Moreover, survival estimates after gastrectomy for gastric cancer were significantly improved when C 15 LNs were examined. Some authors have gone further to recommend greater LN retrieval in advanced, as well as in early, gastric cancer, as patients who had C 26 LNs retrieved had significantly longer 5-year and 10-year survival compared with those who had 15–25 LNs retrieved. We note in the report by Huang and colleagues that examined the SEER data for resected non-metastatic gastric cancer in the United States between 2004 and 2013 that the median number (IQR) of retrieved LNs was 15 (9–23). It would appear, therefore, that approximately half of the patients received an inadequate lymphadenectomy, the influence of which might become increasingly more relevant the higher the number of positive LNs (PLN). The questions I raise are: