Extent of Lymph Node Examination in Older Adults with Gastric Adenocarcinoma: Is There a Trade-off Between Survival and Short-Term Outcomes? : Benefit of Lymph Node Yield in Older Adults with Gastric Cancer
In brief
At least 35 nodes linked to better survival after gastric cancer surgery
In a database study of 47,342 patients, examining at least 35 lymph nodes was associated with better overall survival than examining fewer than 16, including among adults aged 75 and older. Greater node counts were not linked to worse short-term outcomes such as 30-day death or readmission. Because this was observational, it cannot show that more extensive examination caused the survival benefit.
- Journal
- Annals of surgical oncology (Q1)
- Published
- 26 October 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Kim AL, Morocho B, Kwon S
- PMID
- 42934447
- DOI
- 10.1245/s10434-026-20774-2
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 1 November 2026): Nodal yield and survival after gastric cancer gastrectomy
Abstract
BACKGROUND: The optimal extent of lymph node examination in older adults undergoing curative-intent gastric adenocarcinoma treatment remains uncertain, as concerns about postoperative complications and potentially decreased benefit in overall survival may lead surgeons toward more limited dissections. METHODS: Patients with stage I-III gastric adenocarcinoma who underwent gastrectomy between 2010 and 2022 were identified using the National Cancer Database. Patients were stratified by age (< 55, 55-64, 65-74, ≥ 75 years). The primary predictor was number of lymph nodes examined (< 16, 16-24, 25-34, ≥ 35). Overall survival was analyzed using multivariable Cox regression. Modified textbook short-term outcomes (defined by 30-day mortality, readmission, and > 75th percentile length of stay) were analyzed using multivariable logistic regression. Sensitivity analyses were performed in patients aged ≥ 80 and ≥ 85 years. RESULTS: Among the 47,342 patients identified, 11,235 were aged ≥ 75 years. Examination of ≥ 35 lymph nodes compared with < 16 nodes was associated with improved survival in patients aged < 55 years (hazard ratio [HR] 0.72; 95% confidence interval [CI] 0.59-0.87), 55-64 years (HR 0.66; 95% CI 0.57-0.77), 65-74 years (HR 0.67; 95% CI 0.58-0.76), and ≥ 75 years (HR 0.74; 95% CI 0.61-0.91). This was persistent among patients who received preoperative chemotherapy and patients aged ≥ 80 years. Greater nodal yield was not associated with higher odds of adverse modified textbook short-term outcomes in any age group. CONCLUSIONS: Greater nodal yield was associated with improved survival and equivalent or improved short-term outcomes across all age groups, even in older patients. These findings suggest age alone should not justify limiting lymphadenectomy in resectable gastric adenocarcinoma.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.