To the Editor We read with great interest the article by Morgan et al.1 The authors found that the removal of 15 or more lymph nodes was more frequently performed in hospitals with a recognized cancer program. However, survival outcome was associated with lymph node count rather than with cancer program classification.
The National Comprehensive Cancer Network guidelines for gastric cancer suggest that there is no universally accepted minimum number of lymph nodes and that the removal of at least 15 lymph nodes is recommended. However, only 42.3% of patients had a minimum of 15 lymph nodes removed, with 45.5% of patients staying in facilities with cancer program approval, as mentioned in the article by Morgan et al.1 The low proportion of patients with 15 or more harvested lymph nodes may be attributed to an insufficient degree of lymphadenectomies performed and a high number of obese patients. In Western countries, very limited lymphadenectomies are performed compared with East Asian countries, where D2 lymphadenectomies are routinely performed by experienced surgeons with low morbidity and mortality rates.2 And increased body mass index was also reported to be associated with lower lymph node counts.
Yang K, Zhang W, Hu J. Lymph Node Count as a Quality Measure for Gastric Cancer Surgery. JAMA Surg. 2015;150(6):595-596. doi:10.1001/jamasurg.2015.0324