Short‐Term Surgical Outcomes of Palliative Gastrectomy According to the Extent of Lymph Node Dissection: A Nationwide Propensity Score–Weighted Cohort Analysis
Sang‐Ho Jeong, Rock Bum Kim, Miyeong Park, Kyung Won Seo, Jae‐Seok Min,ABSTRACT
Purpose
The appropriate extent of lymph node dissection (LND) during palliative gastrectomy (PALG) for stage IV gastric cancer remains undefined. This study evaluated short‐term surgical outcomes of limited versus extended LND in PALG.
Methods
We analyzed 855 patients undergoing PALG with pathologically confirmed stage IV gastric cancer from the pooled Korean Gastric Cancer Association nationwide survey registries of 2019 ( n = 14,076 and 68 hospitals) and 2023 ( n = 12,752 and 72 hospitals). Patients were stratified by the number of retrieved lymph nodes into limited LND (< 15 nodes and n = 62) and extended LND (≥ 15 nodes and n = 793). Confounding by indication was addressed using overlap (ATO)‐based propensity score weighting (PSW) with double‐robust multivariable regression.
Results
Before weighting, the limited LND group had higher 30‐day complication (43.5% vs. 29.8% and p = 0.023) and mortality rates (17.7% vs. 6.8% and p = 0.005). After ATO‐based PSW (SMD < 0.001 for all covariates), extended LND showed lower odds of 30‐day complications (weighted OR 0.54 [95% CI 0.31–0.95]; double‐robust OR 0.50 [0.28–0.87]); and mortality (double‐robust OR 0.26 [0.10–0.64]). Pneumonia drove the dominant difference (14.8% vs. 3.7% and p < 0.001). Hospital stay remained longer in the limited LND group after weighting (19.9 ± 18.3 vs. 12.8 ± 12.8 days and p < 0.001).
Conclusion
After rigorous adjustment for confounding by indication, extended LND in PALG was not associated with excess short‐term morbidity or mortality. The lower event rates in the extended LND group most likely reflect preferential selection of frailer, more advanced patients for limited LND rather than a causal benefit. In appropriately selected patients at experienced centers, limiting dissection should not be assumed inherently safer.