Long-term survival of patients with stage II and III gastric cancer who underwent gastrectomy with inadequate nodal assessment

doi:10.4240/wjgs.v13.i11.1463

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World Journal of Gastrointestinal Surgery

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Gastrointest Surg. Nov 27, 2021; 13(11): 1463-1483
Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1463

Table 1 Sample characteristics, n (%)

Characteristic	n (%)
Year of diagnosis
2004-2006	3142 (27)
2007-2009	3028 (26)
2010-2012	2850 (25)
2013-2015	2587 (22)
Age at diagnosis (yr)
Median (range)	69 (12-99)
Sex
Male	6697 (58)
Female	4910 (42)
Race
White	7045 (61)
Black	2076 (18)
Asian/Pacific	2486 (21)
Marital status
Single/divorced	2539 (22)
Married	6805 (58)
Widowed	1837 (16)
NA	426 (4)
Insurance status
Insured	8033 (69)
Uninsured	432 (4)
NA	3142 (27)
Site of tumor
Fundus/body	1866 (16)
Antrum/pylorus	4626 (40)
Overlapping lesion	1299 (11)
Stomach, NOS	3816 (33)
Tumor size (cm)
≤ 5	5431 (47)
5.1-10	4203 (36)
≥ 10.1	1135 (10)
NA	838 (7)
Histology
ADC, NOS	4481 (39)
Signet ring cell carcinoma	2726 (23)
ADC, instestinal type	1943 (17)
Carcinoma, diffuse type	958 (8)
ADC with mixed subtypes	424 (4)
Other	1075 (9)
Grade
Well/moderately differentiated	2674 (23)
Poorly/undifferentiated	8524 (73)
NA	409 (4)
T stage, 8^th ed.
T1	290 (2)
T2	943 (8)
T3	5569 (48)
T4a	3551 (31)
T4b	1254 (11)
N stage, 8^th ed.
N0	2863 (25)
N1	2422 (21)
N2	2757 (24)
N3a	2498 (21)
N3b	1067 (9)
Stage, 8^th ed.
IIA	2585 (22)
IIB	2129 (18)
IIIA	3049 (26)
IIIB	2511 (22)
IIIC	1333 (12)
Chemotherapy
Yes	6473 (56)
No	5134 (44)
Neoadjuvant chemotherapy
Yes	1255 (11)
No	10352 (89)
Radiotherapy
Yes	4285 (37)
No	7322 (63)
Type of surgery
Partial gastrectomy	8320 (72)
Total gastrectomy	3287 (28)
Number of retrieved lymphnodes
< 16 LNs (ILA)	5806 (50)
16-29 LNs (ALA)	4085 (35)
≥ 30 LNs (OLA)	1716 (15)

ADC: Adenocarcinoma; ALA: Adequate lymph node assessment; ILA: Inadequate lymph node assessment; LN: Lymph node; NA: Not available, NOS: Not otherwise specified; OLA: Optimal lymph node assessment.

Table 2 Sample characteristics by the number of retrieved lymph nodes, n (%)

Characteristic	ILA	ALA	OLA	P value
Characteristic	n = 5806	n = 4085	n = 1716	P value
Year of diagnosis				< 0.001
2004-2006	1861 (32)	947 (23)	334 (20)
2007-2009	1563 (27)	1071 (26)	394 (23)
2010-2012	1299 (22)	1080 (27)	471 (27)
2013-2015	1083 (19)	987 (19)	517 (30)
Age at diagnosis (yr)				< 0.001
Median (range)	71 (12-99)	68 (14-98)	65 (18-93)
Sex				0.218
Male	3365 (58)	2318 857)	1014 (59)
Female	2441 (42)	1767 (43)	702 (41)
Race				< 0.001
White	3695 (64)	2377 (58)	973 (57)
Black	1061 (18)	747 (18)	268 (15)
Asian/Pacific	1050 (18)	961 (24)	475 (28)
Marital status				< 0.001
Single/divorced	1261 (22)	900 (22)	378 (22)
Married	3282 (57)	2439 (60)	1084 (63)
Widowed	1059 (18)	595 (15)	183 (11)
NA	204 (3)	151 (4)	71 (4)
Insurance status				< 0.001
Insured	3721 (64)	2998 (73)	68 (4)
Uninsured	224 (4)	140 (4)	1314 (77)
NA	1861 (32)	924 (23)	334 (20)
Primary site				< 0.001
Fundus/body	835 (14)	696 (17)	335 (19)
Antrum/pylorus	2562 (44)	1511 (37)	553 (32)
Overlapping lesion	549 (10)	515 (13)	235 (14)
Stomach, NOS	1860 (32)	1363 (33)	593 (35)
Tumor size (cm)				< 0.001
≤ 5	2977 (51)	1808 (44)	646 (38)
5.1-10	1906 (33)	1573 (39)	724 (42)
≥ 10.1	438 (8)	448 (11)	249 (15)
NA	485 (8)	256 (6)	97 (6)
Hystology				< 0.001
ADC, NOS	2426 (42)	1517 (37)	538 (31)
Signet ring cell carcinoma	1248 (22)	997 (24)	481 (28)
ADC, instestinal type	928 (16)	702 (17)	313 (18)
Carcinoma, diffuse type	422 (7)	360 (9)	176 (10)
ADC with mixed subtypes	170 (3)	166 (4)	88 (5)
Other	612 (10)	343 (9)	120 (7)
Grade				< 0.001
Well/moderately differentiated	1493 (26)	862 (21)	319 (19)
Poorly/undifferentiated	4072 (70)	3106 (76)	1346 (78)
NA	241 (4)	117 (3)	51 (3)
T stage, 8^thed.				< 0.001
T1	111 (2)	131 (3)	48 (3)
T2	490 (8)	321 (8)	132 (8)
T3	2877 (50)	1897 (47)	795 (46)
T4a	1658 (29)	1321 (32)	572 (33)
T4b	670 (11)	415 (10)	169 (10)
N stage, 8^th ed.				< 0.001
N0	1810 (31)	794 (19)	259 (15)
N1	1528 (26)	671 (16)	223 (13)
N2	1517 (26)	900 (22)	340 (20)
N3a	951 (16)	1167 (29)	380 (22)
N3b	0	553 (14)	514 (30)
Stage, 8^th ed.				< 0.001
IIA	1557 (27)	775 (19)	253 (15)
IIB	1293 (22)	621 (15)	215 (13)
IIIA	1754 (30)	942 (23)	353 (20)
IIIB	1055 (18)	1091 (27)	365 (21)
IIIC	147 (3)	656 (16)	530 (31)
Chemotherapy				< 0.001
Yes	2814 (48)	2490 (61)	1169 (68)
No	2992 (52)	1595 (39)	547 (32)
Neoadjuvant chemotherapy				< 0.001
Yes	408 (7)	536 (13)	311 (18)
No	5398 (93)	3549 (87)	1405 (82)
Radiotherapy				< 0.001
Yes	1993 (34)	1630 (40)	662 (39)
No	3813 (66)	2455 (60)	1054 (61)
Type of surgery				< 0.001
Partial gastrectomy	4623 (80)	2742 (67)	955 (56)
Total gastrectomy	1183 (20)	1343 (33)	761 (44)

ADC: Adenocarcinoma; NA: Not available; NOS: Not otherwise specified.

Table 3 Cox regression analysis of overall survival and cancer-specific survival

	Overall survival				Cancer-specific survival
Variable	Univariable		Multivariable¹		Univariable		Multivariable¹
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Sex
Male	Reference				Reference
Female	1.03 (0.99-1.08)	0.171			1.07 (1.02-1.13)	0.006
Age, yr
< 70	Reference		Reference		Reference		Reference
≥ 70	1.57 (1.50-1.64)	< 0.001	1.51 (1.43-1.59)	< 0.001	1.32 (1.26-1.39)	< 0.001	1.33 (1.26-1.41)	< 0.001
Race
White	Reference				Reference		Reference
Black	0.97 (0.91-1.03)	0.283	1.11 (1.05-1.18)	0.001	0.97 (0.90-1.03)	0.317	1.10 (1.03-1.18)	0.005
Asian/Pacific	0.80 (0.75-0.85)	< 0.001	0.82 (0.77-0.87)	< 0.001	0.82 (0.77-0.87)	< 0.001	0.83 (0.78-0.89)	< 0.001
Insurance status
NA	Reference				Reference
Insured	0.92 (0.88-0.97)	0.001			1.05 (0.91-1.21)	0.550
Uninsured	0.96 (0.84-1.09)	0.501			0.95 (0.83-1.09)	0.459
Site of tumor
Fundus-body	Reference				Reference
Antrum-pylorus	1.08 (1.01-1.15)	0.030			1.08 (0.99-1.16)	0.055
Overlapping lesion of the stomach	1.30 (1.19-1.42)	< 0.001			1.35 (1.23-1.49)	< 0.001
Stomach, NOS	1.05 (0.98-1.13)	0.167			1.04 (0.96-1.12)	0.373
Histology
ADC, NOS	Reference		Reference		Reference		Reference
Signet ring cell carcinoma	1.16 (1.09-1.23)	< 0.001	1.14 (1.07-1.21)	< 0.001	1.28 (1.20-1.37)	< 0.001	1.16 (1.09-1.25)	< 0.001
ADC, instestinal type	0.87 (0.81-0.93)	< 0.001	0.98 (0.91-1.05)	0.547	0.79 (0.73-0.86)	< 0.001	0.93 (0.86-1.01)	0.086
Carcinoma, diffuse type	1.15 (1.06-1.26)	0.001	1.12 (1.03-1.23)	0.011	1.22 (1.11-1.34)	< 0.001	1.11 (1.00-1.22)	0.045
ADC with mixed subtypes	1.06 (0.94-1.20)	0.349	1.09 (0.96-1.24)	0.169	1.12 (0.98-1.28)	0.103	1.08 (0.94-1.24)	0.281
Other	0.92 (0.85-1.00)	0.062	0.97 (0.89-1.06)	0.543	0.95 (0.86-1.04)	< 0.001	1.01 (0.92-1.11)	0.862
T stage, 8^th ed.
T1	Reference		Reference		Reference		Reference
T2	1.13 (0.93-1.36)	0.217	1.08 (0.88-1.32)	0.455	1.12 (0.89-1.41)	0.322	1.01 (0.79-1.28)	0.963
T3	1.52 (1.28-1.80)	< 0.001	1.37 (1.09-1.73)	0.008	1.69 (1.37-2.07)	< 0.001	1.34 (1.02-1.76)	0.033
T4a	2.34 (1.98-2.78)	< 0.001	1.72 (1.33-2.22)	< 0.001	2.89 (2.35-3.55)	< 0.001	1.70 (1.27-2.28)	< 0.001
T4b	2.83 (2.37-3.38)	< 0.001	2.08 (1.48-2.93)	< 0.001	3.54 (2.86-4.39)	< 0.001	2.06 (1.40-3.01)	< 0.001
N stage, 8^th ed.
N0	Reference		Reference		Reference		Reference
N1	1.22 (1.14-1.31)	< 0.001	1.30 (1.16-1.46)	< 0.001	1.31 (1.21-1.43)	< 0.001	1.26 (1.10-1.43)	0.001
N2	1.49 (1.39-1.59)	< 0.001	1.49 (1.28-1.73)	< 0.001	1.70 (1.57-1.84)	< 0.001	1.44 (1.22-1.70)	< 0.001
N3a	2.05 (1.92-2.19)	< 0.001	2.10 (1.61-2.74)	< 0.001	2.51 (2.32-2.71)	< 0.001	2.06 (1.55-2.76)	< 0.001
N3b	2.90 (2.66-3.15)	< 0.001	3.22 (2.17-4.80)	< 0.001	3.68 (3.36-4.03)	< 0.001	3.29 (2.14-5.05)	< 0.001
Stage, 8^th ed.
IIA	Reference		Reference		Reference		Reference
IIB	1.34 (1.24-1.45)	< 0.001	1.17 (1.05-1.31)	0.005	1.62 (1.47-1.78)	< 0.001	1.38 (1.22-1.57)	< 0.001
IIIA	1.96 (1.83-2.10)	< 0.001	1.43 (1.21-1.70)	< 0.001	2.53 (2.33-2.75)	< 0.001	1.78 (1.48-2.15)	< 0.001
IIIB	2.47 (2.30-2.66)	< 0.001	1.44 (1.08-1.92)	0.012	3.38 (3.11-3.68)	< 0.001	1.87 (1.37-2.55)	< 0.001
IIIC	3.68 (3.39-3.99)	< 0.001	1.59 (1.04-2.44)	0.034	5.19 (4.73-5.70)	< 0.001	2.05 (1.29-3.26)	0.003
Grade
Well/moderately differentiated	Reference		Reference		Reference
Poorly/undifferentiated	1.35 (1.28-1.43)	< 0.001	1.19 (1.12-1.26)	< 0.001	1.59 (1.49-1.70)	< 0.001
Type of surgery
Partial gastrectomy	Reference		Reference		Reference		Reference
Total gastrectomy	1.25 (1.19-1.32)	< 0.001	1.23 (1.17-1.30)	< 0.001	1.32 (1.25-1.40)	< 0.001	1.22 (1.15-1.29)	< 0.001
Chemotherapy
No	Reference		Reference		Reference		Reference
Yes	0.62 (0.59-0.64)	< 0.001	0.68 (0.64-0.72)	< 0.001	0.71 (0.67-0.74)	< 0.001	0.73 (0.68-0.78)	< 0.001
Neoadjuvant chemotherapy
No	Reference				Reference
Yes	0.76 (0.71-0.83)	< 0.001			0.82 (0.75-0.89)	< 0.001
Radiotherapy
No	Reference		Reference		Reference		Reference
Yes	0.65 (0.62-0.68)	< 0.001	0.77 (0.73-0.82)	< 0.001	0.70 (0.66-0.73)	< 0.001	0.75 (0.71-0.80)	< 0.001
Number of retrieved lymph nodes
ILA	Reference		Reference		Reference		Reference
ALA	0.84 (0.79-0.88)	< 0.001	0.68 (0.64-0.71)	< 0.001	0.85 (0.81-0.90)	< 0.001	0.64 (0.60-0.68)	< 0.001
OLA	0.73 (0.68-0.79)	< 0.001	0.48 (0.44-0.52)	< 0.001	0.80 (0.74-0.86)	< 0.001	0.47 (0.43-0.51)	< 0.001

¹Forward selection model. ADC: Adenocarcinoma; ALA: Adequate lymph node assessment; CI: Confidence interval; HR: Hazard ratio; ILA: Inadequate lymph node assessment; OLA: Optimal lymph node assessment; NA: Not available, NOS: Not otherwise specified.

Table 4 Propensity score matching subgroups

Characteristic	ALA, n = 1714	OLA, n = 1714	P value
Year of diagnosis			0.978
2004-2006	339 (20)	334 (19)
2007-2009	385 (23)	394 (23)
2010-2012	468 (27)	471 (28)
2013-2015	522 (30)	515 (30)
Age at diagnosis (yr)			0.861
Median (range)	66 (14-98)	66 (18-93)
Sex			0.945
Male	1011 (59)	1013 (59)
Female	703 (41)	701 (41)
Race			0.181
White	972 (57)	973 (57)
Black	303 (18)	268 (16)
Asian/Pacific	439 (25)	473 (28)
Marital status			0.234
Single/divorced	389 (23)	378 (22)
Married	1035 (60)	1082 (63)
Widowed	218 (13)	183 (71)
NA	72 (4)	71 (4)
Insurance status			0.958
Insured	1305 (76)	1312 (77)
Uninsured	339 (20)	334 (19)
NA	70 (4)	68 (4)
Primary site			0.926
Fundus/body	327 (19)	333 (19)
Antrum/pylorus	571 (33)	553 (32)
Overlapping lesion	235 (14)	235 (14)
Stomach, NOS	581 (34)	593 (35)
Tumor size (cm)			0.016
≤ 5	737 (43)	645 (38)
5.1-10	663 (39)	724 (42)
≥ 10.1	222 (13)	248 (15)
NA	92 (5)	97 (6)
Hystology			0.046
ADC, NOS	557 (32)	538 (31)
Signet ring cell carcinoma	492 (29)	480 (28)
ADC, Instestinal type	289 (17)	313 (18)
Carcinoma, diffuse type	177 (10)	175 (10)
ADC with mixed subtypes	69 (4)	88 (5)
Other	130 (8)	110 (7)
Grade			0.892
Well/moderately differentiated	310 (18)	319 (19)
Poorly/undifferentiated	1351 (79)	1345 (79)
NA	53 (3)	50 (3)
T stage, 8^th ed.			0.553
T1	59 (3)	48 (3)
T2	137 (8)	132 (8)
T3	769 (45)	793 (46)
T4a	597 (35)	572 (33)
T4b	152 (9)	169 (10)
N stage, 8^th ed.			0.659
N0	250 (15)	259 (15)
N1	252 (15)	223 (13)
N2	342 (20)	340 (20)
N3a	380 (22)	380 (22)
N3b	490 (29)	512 (30)
Stage, 8^th ed.			0.808
IIA	263 (15)	253 (15)
IIB	226 (13)	215 (13)
IIIA	351 (21)	353 (21)
IIIB	377 (22)	365 (21)
IIIC	497 (29)	528 (30)
Chemotherapy			0.025
Yes	1105 (65)	1167 (32)
No	609 (35)	1167 (68)
Neoadjuvant chemotherapy			< 0.001
Yes	225 (13)	310 (18)
No	1499 (87)	1404 (82)
Radiotherapy			0.051
Yes	718 (42)	662 (39)
No	996 (58)	1052 (61)
Type of surgery			< 0.001
Partial gastrectomy	1099 (64)	955 (56)
Total gastrectomy	615 (36)	759 (44)

ADC: Adenocarcinoma; ALA: Adequate lymph node assessment; NOS: Not otherwise specified; OLA: Optimal lymph node assessment.

Table 5 Kaplan-Meier estimates in propensity score matching subgroups

	Median OS, mo(95%CI)	P value	Median CSS, mo(95%CI)	P value
ALA	26 (23.5-28.4)	< 0.001	31 (27.3-34.7)	< 0.001
OLA	34 (30.0-38.0)		42 (35.9-48.1)

ALA: Adequate lymph node assessment; CI: confidence interval; CSS: Cancer-specific survival; OLA: Optimal lymph node assessment; OS: Overall survival.

Table 6 Overall survival Cox regression results for overall survival and cancer-specific survival after propensity score matching

	Overall survival				Cancer-specific survival
Variable	Univariable		Multivariable¹		Univariable		Multivariable¹
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Sex
Male	Reference				Reference
Female	0.98 (0.90-1.07)	0.662			1.03 (0.94-1.14)	0.517
Age
< 70	Reference				Reference
≥ 70	1.56 (1.43-1.71)	< 0.001			1.35 (1.23-1.49)	< 0.001
Race
White	Reference				Reference		Reference
Black	0.96 (0.85-1.08)	0.528	1.10 (0.97-1.24)	0.147	0.94 (0.83-1.08)	0.383	1.08 (0.94-1.23)	0.274
Asian/pacific	0.80 (0.72-0.89)	< 0.001	0.84 (0.75-0.93)	0.001	0.81 (0.72-0.90)	< 0.001	0.87 (0.77-0.97)	0.014
Insurance status
NA	Reference				Reference
Insured	0.87 (0.79-0.97)	0.009			0.87 (0.78-0.97)	0.013
Uninsured	0.99 (0.78-1.27)	0.972			0.96 (0.74-1.25)	0.754
Site of tumor
Fundus-body	Reference				Reference
Antrum-pylorus	1.07 (0.95-1.22)	0.275			1.11 (0.97-1.27)	0.140
Overlapping lesion of the stomach	1.33 (1.15-1.55)	< 0.001			1.39 (1.18-1.64)	< 0.001
Stomach, NOS	1.04 (0.92-1.18)	0.516			1.03 (0.90-1.19)	0.631
Histology
ADC, NOS	Reference				Reference		Reference
Signet ring cell carcinoma	1.26 (1.13-1.41)	< 0.001			1.37 (1.22-1.54)	< 0.001	1.22 (1.08-1.38)	0.001
ADC, instestinal type	0.89 (0.79-1.03)	0.114			0.81 (0.70-0.95)	0.008	0.91 (0.78-1.06)	0.238
Carcinoma, diffuse type	1.23(1.06-1.44)	0.008			1.29 (1.09-1.52)	0.003	1.18 (0.99-1.40)	0.054
ADC with mixed subtypes	1.15 (0.93-1.43)	0.193			1.28 (1.02-1.60)	0.032	1.13 (0.89-1.42)	0.318
Other	0.93 (0.77-1.13)	0.472			0.99 (0.81-1.21)	0.913	1.15 (0.93-1.41)	0.199
T stage, 8^th ed
T1	Reference				Reference
T2	1.18 (0.83-1.67)	0.356			1.43 (0.91-2.24)	0.121
T3	1.85 (1.37-2.51)	< 0.001			2.60 (1.74-3.87)	< 0.001
T4a	2.84 (2.10-3.86)	< 0.001			4.28 (2.87-6.39)	< 0.001
T4b	3.44 (2.49-4.75)	< 0.001			5.13 (3.39-7.77)	< 0.001
N stage, 8^th ed
N0	Reference				Reference
N1	1.09 (0.89-1.34)	0.380			1.08 (0.86-1.36)	0.518
N2	1.56 (1.31-1.87)	< 0.001			1.63 (1.33-1.99)	< 0.001
N3a	2.28 (1.93-2.69)	< 0.001			2.61 (2.16-3.16)	< 0.001
N3b	4.58 (3.91-5.37)	< 0.001			5.50 (4.59-6.58)	< 0.001
Stage, 8^th ed
IIA	Reference		Reference		Reference		Reference
IIB	1.38 (1.12-1.70)	0.003	1.47 (1.18-1.81)	< 0.001	1.70 (1.33-2.18)	< 0.001	1.77 (1.38-2.29)	< 0.001
IIIA	1.96 (1.63-2.35)	< 0.001	2.21 (1.83-2.66)	< 0.001	2.39 (1.92-2.98)	< 0.001	2.66 (2.12-3.32)	< 0.001
IIIB	2.85 (2.39-3.40)	< 0.001	3.31 (2.76-3.96)	< 0.001	3.75 (3.04-6.64)	< 0.001	4.22 (3.40-5.23)	< 0.001
IIIC	5.73 (4.85-6.77)	< 0.001	6.32 (5.31-7.52)	< 0.001	8.06 (6.58-9.88)	< 0.001	8.58 (6.97-10.57)	< 0.001
Grade
Well/moderately differentiated	Reference		Reference		Reference
Poorly/undifferentiated	1.52 (1.35-1.72)	< 0.001	1.19 (1.05-1.35)	0.007	1.70 (1.49-1.96)	< 0.001
Type of surgery
Partial gastrectomy	Reference		Reference		Reference		Reference
Total gastrectomy	1.40 (1.29-1.53)	< 0.001	1.28 (1.17-1.40)	< 0.001	1.43 (1.31-1.58)	< 0.001	1.24 (1.13-1.37)	< 0.001
Chemotherapy
No	Reference		Reference		Reference		Reference
Yes	0.56 (0.51-0.61)	< 0.001	0.63 (0.56-0.70)	< 0.001	0.61 (0.55-0.67)	< 0.001	0.66 (0.89-0.74)	< 0.001
Neoadjuvant chemotherapy
No	Reference		Reference		Reference		Reference
Yes	0.71 (0.62-0.81)	< 0.001	1.48 (1.35-1.63)	< 0.001	0.76 (0.66-0.87)	< 0.001	1.33 (1.20-1.48)	< 0.001
Radiotherapy
No	Reference		Reference		Reference		Reference
Yes	0.64 (0.59-0.70)	< 0.001	0.77 (0.69-0.86)	< 0.001	0.67 (0.61-0.73)	< 0.001	0.76 (0.68-0.85)	< 0.001
Number of retrieved lymph nodes
ALA	Reference		Reference		Reference		Reference
OLA	0.81 (0.75-0.89)	< 0.001	0.71 (0.65-0.78)	< 0.001	0.84 (0.76-0.92)	< 0.001	0.74 (0.67-0.82)	< 0.001

¹Forward selection model. ADC: Adenocarcinoma; ALA: Adequate lymph node assessment; ILA: Inadequate lymph node assessment; NA: Not available, NOS: Not otherwise specified; OLA: Optimal lymph node assessment.

Citation: Desiderio J, Sagnotta A, Terrenato I, Garofoli E, Mosillo C, Trastulli S, Arteritano F, Tozzi F, D'Andrea V, Fong Y, Woo Y, Bracarda S, Parisi A. Long-term survival of patients with stage II and III gastric cancer who underwent gastrectomy with inadequate nodal assessment. World J Gastrointest Surg 2021; 13(11): 1463-1483
URL: https://www.wjgnet.com/1948-9366/full/v13/i11/1463.htm
DOI: https://dx.doi.org/10.4240/wjgs.v13.i11.1463