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D2 lymph node dissection confers little benefit on the overall survival of older patients with resectable gastric cancer: a propensity score-matching analysis of a multi-institutional dataset

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Abstract

Purpose

Aging societies comprise an increasing number of elderly gastric cancer (GC) patients. We herein attempted to determine whether D2 lymphadenectomy is beneficial for older GC patients.

Methods

We retrospectively analyzed a multi-institutional dataset including 3484 patients who received surgical resection for GC. For the analysis, we selected patients aged ≥ 80 years who were clinically diagnosed with T1N + or T2-4 GC. To balance the essential variables including the type of gastrectomy and the stage of progression, propensity score matching was conducted, and we compared the background clinical factors and postoperative outcomes of the patients allocated to the D2 (n = 87) and non-D2 (n = 87) dissection groups.

Results

The D2 group had significantly longer operative times, more blood loss, and more retrieved lymph nodes (median 32 vs 24, P < 0.001) than the non-D2 group. The D2 group had a greater incidence of intra-abdominal abscesses (grade ≥ II in the Clavien–Dindo classification) than the non-D2 group (3.5% vs 0%, P = 0.040). The overall disease-specific and relapse-free survival rates of the D2 group tended to be poorer than those of the non-D2 group (hazard ratios 1.49, 1.70 and 1.14, respectively).

Conclusions

D2 lymphadenectomy for older patients with GC conferred little benefit regarding overall survival despite an occurrence of increased complication rates.

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Authors and Affiliations

  1. Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan

    Takahiro Shinozuka & Toshifumi Murai

  2. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Takahiro Shinozuka, Mitsuro Kanda, Chie Tanaka, Daisuke Kobayashi, Michitaka Fujiwara & Yasuhiro Kodera

  3. Department of Surgery, Komaki City Hospital, Komaki, Japan

    Takahiro Shinozuka & Yoshinari Mochizuki

  4. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan

    Seiji Ito

  5. Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan

    Hitoshi Teramoto

  6. Department of Surgery, Konan Kosei Hospital, Konan, Japan

    Kiyoshi Ishigure

  7. Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan

    Takahiro Asada

  8. Department of Surgery, Okazaki City Hospital, Okazaki, Japan

    Akiharu Ishiyama

  9. Department of Surgery, Tosei General Hospital, Seto, Japan

    Hidenobu Matsushita

  10. Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan

    Kenta Murotani

Authors
  1. Takahiro Shinozuka
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  2. Mitsuro Kanda
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  3. Seiji Ito
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  4. Yoshinari Mochizuki
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  9. Akiharu Ishiyama
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  15. Yasuhiro Kodera
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Corresponding author

Correspondence to Mitsuro Kanda.

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Takahiro Shinozuka and other co-authors have no conflicts of interest to declare in association with this study.

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Shinozuka, T., Kanda, M., Ito, S. et al. D2 lymph node dissection confers little benefit on the overall survival of older patients with resectable gastric cancer: a propensity score-matching analysis of a multi-institutional dataset. Surg Today 50, 1434–1442 (2020). https://doi.org/10.1007/s00595-020-02021-7

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  • DOI: https://doi.org/10.1007/s00595-020-02021-7

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