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Gastrectomy with Extended Lymphadenectomy: a North American Perspective

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

Despite evidence of oncologic benefits from extended (D2) lymphadenectomy in gastric cancer from many East Asian studies, there is persistent debate over its use in the West, mainly due to perceived high rates of morbidity and mortality. This study evaluates the safety and efficacy of D2 dissection in a high-volume North American center.

Methods

A prospectively entered database of all patients undergoing gastrectomy for cancer at a North American referral center from 2005 to 2016 was reviewed. Wedge resections, thoracoabdominal approach, emergency surgery, palliative operations, and non-adenocarcinoma cases were excluded.

Results

Of 366 non-bariatric gastrectomies over this period, 175 met the inclusion criteria. Median age was 73 years and 69% were male. One hundred forty-one patients (80%) underwent D2 dissection, the rest having D1. There was no difference in postoperative complications (D1 = 44%: D2 = 42%), anastomotic leaks (D1 = 6%: D2 = 5%), and same-admission or 30-day mortality (D1 = 6%: D2 = 2%). D2 dissection was associated with higher pathological stage (72% > stage 1 vs 38% > stage 1; p < 0.05) and median lymph node yield (30 vs 14; p < 0.05), with no difference in complete resection (R0) rate (D1 = 98% vs D2 = 92%). Laparoscopic approach was employed in 34% (45/141) of D2 cases, resulting in shorter median length of stay (6 days vs 9; p < 0.05) and equivalent oncologic outcomes compared to open D2.

Conclusion

This study supports the use of D2 lymphadenectomy, by either open or laparoscopic approach, in high-volume North American centers as a safe and effective oncologic procedure for gastric cancer, with equivalent complication rates and superior lymph node yield to traditional D1 dissection.

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Author information

Authors and Affiliations

  1. Department of General Surgery, McGill University Health Centre, Montreal, QC, Canada

    Alexandre Gosselin-Tardif & Jessica Lie

  2. Division of Thoracic Surgery, McGill University Health Centre, Montreal, QC, Canada

    Ioana Nicolau, Juan Carlos Molina, Jonathan Cools-Lartigue, Jonathan Spicer, Carmen Mueller & Lorenzo Ferri

  3. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    Liane Feldman

Authors
  1. Alexandre Gosselin-Tardif
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  2. Jessica Lie
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  4. Juan Carlos Molina
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  5. Jonathan Cools-Lartigue
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  6. Liane Feldman
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  7. Jonathan Spicer
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  8. Carmen Mueller
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  9. Lorenzo Ferri
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Contributions

Alexandre Gosselin-Tardif contributed to study design, to data acquisition and analysis, as well as to manuscript drafting.

Jessica Li contributed to data acquisition and analysis, as well as to manuscript revision.

Ioana Nicolau contributed to data analysis and interpretation, as well as to manuscript revision.

Juan Carlos Molina contributed to data acquisition and to manuscript revision.

Jonathan Cools-Lartigue contributed to data acquisition and to manuscript revision.

Liane Feldman contributed to study design, to data interpretation, and to manuscript revision.

Jonathan Spicer contributed to study design, to data interpretation, and to manuscript revision.

Carmen Mueller contributed to study design, to data interpretation, and to manuscript drafting and revision.

Lorenzo Ferri contributed to study design, to data interpretation, and to manuscript revision.

All authors have given final approval of the version to be published, and all have agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Alexandre Gosselin-Tardif.

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Gosselin-Tardif, A., Lie, J., Nicolau, I. et al. Gastrectomy with Extended Lymphadenectomy: a North American Perspective. J Gastrointest Surg 22, 414–420 (2018). https://doi.org/10.1007/s11605-017-3633-5

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  • DOI: https://doi.org/10.1007/s11605-017-3633-5

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