Advertisement

Annals of Surgical Oncology

, Volume 7, Issue 3, pp 210–217 | Cite as

Survival benefit of D2 lymphadenectomy in patients with gastric adenocarcinoma

  • Luis F. Oñate-Ocaña
  • Vincenzo Aiello-Crocifoglio
  • Ricardo Mondragón-Sánchez
  • Juan M. Ruiz-Molina
Article

Abstract

Background

A definite resolution to the controversy on the optimal extension of lymph node dissection (LND) in gastric cancer has not been achieved. Surgical morbidity and survival of D1 and D2 LND are compared by multivariate analysis.

Methods

A retrospective cohort study of 219 patients with gastric cancer and curative resection performed according to Japanese rules. D1 dissection was performed in 106 cases and D2 in 113. The logistic regression model was used to define risk factors for surgical morbidity and the Cox model to determine prognostic factors.

Results

Surgical morbidity occurs in 16.9% and 19.5% in D1 and D2 LND, respectively (P=.7). The morbidity determinants were operation blood loss, splenectomy, pancreaticosplenectomy, antrum location, low serum albumin, total gastrectomy, and metastatic nodal ratio (P<.0001), but not D2 LND. Five-year survival was 35.1% for D1 and 64% for D2 LND (P<.039). The prognostic factors were T stage, N stage, serum albumin level, total gastrectomy, D2 LND, and comorbidity (P<.0001).

Conclusions

The increment of surgical morbidity and mortality rates attributed to D2 LND is largely caused by the effect of splenectomy and pancreaticosplenectomy. A significant survival benefit because of D2 LND was found. The results support the value of extended LND in the surgical treatment of gastric cancer.

Key Words

Gastric adenocarcinoma Lymphadenectomy Surgical morbidity Prognostic factors Splenectomy and pancreatectomy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H. Surgical treatment for gastric cancer: the Japanese approach.Semin Oncol 1996;23:360–8.PubMedGoogle Scholar
  2. 2.
    Siewert JR, Roder JD, Böttcher K, et al, the German Gastric Carcinoma Study Group. Prognostic relevance of systematic lymph node dissection in gastric carcinoma.Br J Surg 1993;80:1015–8.PubMedGoogle Scholar
  3. 3.
    Dent DM, Madden MV, Price SK. Randomized comparison of R1 and R2 gastrectomy for gastric cancer.Br J Surg 1988;75:110–2.PubMedGoogle Scholar
  4. 4.
    Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients.Lancet 1995;345:745–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJH, and the Dutch Gastric Cancer Group. Extended lymph-node dissection for gastric cancer.N Engl J Med 1999;340:908–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Cuschieri A, Fayers P, Fielding J, and the Surgical Cooperative Group. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial.Lancet 1996;347:995–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial: Surgical Co-operative Group.Br J Cancer 1999;79:1523–30.CrossRefGoogle Scholar
  8. 8.
    Wanebo HJ, Kennedy BJ, Winchester DP, Stewart AK, Fremgen AM. Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on long-term survival.J Am Coll Surg 1997;185:177–84.PubMedCrossRefGoogle Scholar
  9. 9.
    Kwon SJ. Prognostic impact of splenectomy on gastric cancer: results of the Korean Gastric Cancer Study Group.World J Surg 1997;21:837–44.PubMedCrossRefGoogle Scholar
  10. 10.
    Japanese Research Society for Gastric Cancer. The general rules for gastric cancer study in surgery and pathology.Jpn J Surg 1981;11:127–45.CrossRefGoogle Scholar
  11. 11.
    Japanese Research Society for Gastric Cancer. Japanese classification of gastric carcinoma (English ed 1) Tokyo, Kanehara, 1995.Google Scholar
  12. 12.
    Beahrs OH, Henson DE, Hutter RVP, Kennedy BJ, eds.Manual for Staging of Cancer. 4th ed. Philadelphia: J.B. Lippincott, 1992: 63–7.Google Scholar
  13. 13.
    Kaplan EL, Meier PM. Nonparametric estimation from incomplete observations.J Am Stat Soc 1958;53:457–81.Google Scholar
  14. 14.
    Feinstein AR. Multiple logistic regression. In:Multivariable Analysis: An Introduction. New Haven, CT: Yale University Press, 1996:297–330.Google Scholar
  15. 15.
    Feinstein AR. Proportional hazards analysis (Cox regression). In:Multivariable Analysis: An Introduction. New Haven, CT: Yale University Press, 1996:370–97.Google Scholar
  16. 16.
    Oñate-Ocaña LF, Aiello-Crocifoglio V, Mondragón-Sánchez R, Ruiz-Molina JM, Gallardo-Rincon D. Prognostic factors in 793 cases of gastric cancer.Rev Gastroenterol Mex 1999;64:114–21.PubMedGoogle Scholar
  17. 17.
    Secretaria de Salud. Estomago. In: Compendio del Registro Histopatologico de Neoplasias Malignas en Mexico. Mexico: Direccion General de Epidemiologia, 1994:59.Google Scholar
  18. 18.
    Robertson CS, Chung SCS, Woods SDS, et al. A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer.Ann Surg 1994;220:176–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Gouzi JL, Huguier M, Fagniez PL, et al. Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum: a French prospective controlled study.Ann Surg 1989;209:162–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Noguchi Y, Imada T, Matsumoto A, Coit DG, Brennan MF. Radical surgery for gastric cancer: a review of the Japanese experience.Cancer 1989;64:2053–62.PubMedCrossRefGoogle Scholar
  21. 21.
    Bunt AMG, Hogendoorn PCW, van de Velde CJH, Bruijn JA, Hermans J. Lymph node staging standards in gastric cancer.J Clin Oncol 1995;13:2309–16.PubMedGoogle Scholar
  22. 22.
    Roder JD, Bonenkamp JJ, Craven J, et al. LND for gastric cancer in clinical trials: update.World J Surg 1995;19:546–53.PubMedCrossRefGoogle Scholar
  23. 23.
    Bunt AMG, Hermans J, Smit VTH, van de Velde CJH, Fleuren GJ, Bruijn JA. Surgical/pathological-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries. J Clin Oncol 1995;13:19–25.PubMedGoogle Scholar
  24. 24.
    Bunt AMG, Hermans J, van de Velde CJH, et al. Lymph node retrieval in a randomized trial on Western-type versus Japanese-type surgery in gastric cancer.J Clin Oncol 1996;14:2289–94.PubMedGoogle Scholar
  25. 25.
    Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Okajima K. Pancreas-preserving total gastrectomy for proximal gastric cancer.World J Surg 1995;19:532–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Sasako M, McCulloch P, Kinoshita T, Maruyama K. A new method to evaluate the therapeutic value of lymph node dissection for gastric cancer.Br J Surg 1995; 82:346–51.PubMedGoogle Scholar
  27. 27.
    Roukos DH, Encke A, Lorenz M. Evidence of survival benefit of extended (D2) LND in western patients with gastric cancer based on a new concept: a prospective long-term follow-up study.Surgery 1998;123:573–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Siewert JR, Kestlmeier R, Busch R, et al. Benefits of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases.Br J Surg 1996;83:1144–7.PubMedGoogle Scholar
  29. 29.
    Kodera Y, Yamamura Y, Shimizu Y, et al. Metastatic gastric lymph node rate is a significant prognostic factor for resectable stage IV stomach cancer.J Am Coll Surg 1997;185:65–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Pacelli F, Doglietto GB, Bellantone F, Alfieri S, Sgadari A, Crucitti F. Extensive versus limited lymph node dissection for gastric cancer: a comparative study of 320 patients.Br J Surg 1993;80:1153–6.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2000

Authors and Affiliations

  • Luis F. Oñate-Ocaña
    • 1
  • Vincenzo Aiello-Crocifoglio
    • 1
  • Ricardo Mondragón-Sánchez
    • 1
  • Juan M. Ruiz-Molina
    • 1
  1. 1.Departamento de GastroenterologiaInstituto Nacional de CancerologíaMexico DFMexico

Personalised recommendations