We tried to determine the role of the body mass index (BMI) on the extent of lymph node dissection in gastric cancer surgery. Seven hundred and eighty-seven patients with gastric carcinoma were reviewed. Ninety-two (11%) patients exceeded the upper limit of the optimum BMI. Significantly fewer lymph nodes were removed following D2 (p = 0.002) and ≥D3 (p = 0.023) dissections, and the lymph node ratio was significantly (p = 0.0383) higher in overweight patients. The recurrence-free survival was significantly (p = 0.0297) shorter in T2/T3 cases with high BMI, and BMI (relative risk 1.85) became an independent prognostic factor in multivariate analysis. Higher BMI hampers regional lymph node dissection in gastric cancer patients and became an independent predictor of disease recurrences in T2/T3 gastric cancers.

Patients with transmural (T2N0-T3N2) advanced gastric carcinoma comprise the largest group with uncertain outcome. These patients must be stratified according to the prognostic variables so the high risk group can be precisely identified. A total of 152 patients with transmural advanced gastric carcinomas were uniformly treated with a curative intent between 1979 and 1989 with at least a 7-year follow-up. Results and prognostic factors of long-term survival were analyzed by univariate and multivariate analyses. Seventy-five (49%) patients with advanced gastric carcinoma survived more than 7 years, which indicates the curative nature of surgery for gastric carcinoma. Seventeen variables were evaluated by univariate analysis. In the multivariate analysis, patient's age [>70 years, relative risk (RR) 2.4)], intraoperative blood loss (>500 ml, RR 1.7), blood vessel invasion (RR 2.3), ratio of invaded dissected lymph nodes (>0.2, RR 3.0), and tumors penetrating the serosa (RR 3.9) were the independent prognostic variables. The results of this study indicate that extensive lymphadenectomy and minimal intraoperative blood loss might be helpful for improving patient survival following a curative resection. Patients with vessel invasion, serosal involvement, and those >70 years of age should be considered at high risk and require appropriate adjuvant therapy to prolong survival.

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Results indicate that gastric cancer in elderly patients has a poorer prognosis than that in younger patients.

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