Skip to main content
SpringerLink
Log in

Is D2 lymph node dissection necessary for early gastric cancer?

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to clarify a survival benefit of D2 lymphadenectomy in patients with early gastric carcinoma (GC).

Methods

A retrospective study was conducted to examine the incidence of metastasis to level 2 lymph nodes, the causes of postoperative death, and the mode of recurrence in 1041 patients who head early GC and underwent D2 lymphadenectomy with curative intent.

Results

Postoperative mortality occurred in 129 (12,4%) of 1041 patients, 6 patients (.6%) died of surgical complications 108 (10.2%) died of diseases other than cancer, and 16 (1.5%) died of recurrence. Hematogenous metastasis was the major mode of recurrence (56.3% of recurrences). The incidence of metastasis to level 2 nodes was 2.5% (26 of 1041 patients, 18 of whom were alive). Thus, the estimated survival benefit of radical lymphadenectomy for patients with early GC was calculated to be 1.7% (18 of 1041 patients).

Conclusions

D2 lymphadenectomy in patients with early GC had little survival benefit because (1) metastasis to level 2 nodes was rare, (2) most causes of death were not related to the tumor, and (3) more than half the recurrences were hematogenous. Use of radical lymphadenectomy for early GC should be limited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Japanese Research Society for Gastric Cancer. The general rules for gastric cancer study in surgery and pathology.Jpn J Surg 1981;11:127–39.

    Article  Google Scholar 

  2. Hochwald SN, Brennan MF, Klimstra DS, Kim S, Karpeh MS. Is lymphadenectomy necessary for early gastric cancer?Ann Surg Oncol 1999;6:664–70.

    Article  PubMed  CAS  Google Scholar 

  3. Sue-Ling HM, Martin I, Griffith J, et al. Early gastric cancer: 46 cases treated in one surgical department.Gut 1992;33:1318–22.

    PubMed  CAS  Google Scholar 

  4. Itoh H, Oohata Y, Nakamura K, Nagata T, Mibu R, Nakayama F. Complete ten-year postgastrectomy follow-up of early gastric cancer.Am J Surg 1989;158:14–6.

    Article  PubMed  CAS  Google Scholar 

  5. Ohta H, Noguchi Y, Takagi K, Nishi M, Kajitani T, Kato Y. Early gastric carcinoma with special reference to macroscopic classification.Cancer 1987;60:1099–106.

    Article  PubMed  CAS  Google Scholar 

  6. Kito T, Yamamura Y, Kobayashi S. Surgical treatment of early gastric cancer.Anticancer Res 1989;8:335–8.

    Google Scholar 

  7. Koga S, Kaibara N, Tamura H, Nishidoi H, Kimura O. Cause of late postoperative death in patients with early gastric cancer: special reference to recurrence and the incidence of metachronous primary cancer in other organ.Surgery 1984;6:511–6.

    Google Scholar 

  8. Kitaoka T, Yoshikawa K, Hirota T, Itabashi M. Surgical treatment of early gastric cancer.Jpn J Clin Oncol 1984;14:283–93.

    PubMed  CAS  Google Scholar 

  9. Okamura T, Tsujitani S, Korenaga D, et al. Lymphadenectomy for cure in patients with early gastric cancer and lymph node metastasis.Am J Surg 1988;155:476–80.

    Article  PubMed  CAS  Google Scholar 

  10. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limit of radicality.World J Surg 1987;11:418–25.

    Article  PubMed  CAS  Google Scholar 

  11. 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.

    Article  PubMed  CAS  Google Scholar 

  12. Everett SM, Axon ATR. Early gastric cancer in Europe.Gut 1997;41:142–50.

    Article  PubMed  CAS  Google Scholar 

  13. Livingston EH. Stomach and duodenum. Gastric carcinoma. In: Norton JA, Bollinger RR, Chang AE, Lowry SF, Mulvihill SJ, Pass HI, Thompson RW, eds.Surgery. Basic Science and Clinical Evidence. New York, Springer-Verlag, Inc., 2001:504–9.

    Google Scholar 

  14. Bonenkamp JJ, Songun J, 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.

    Article  PubMed  CAS  Google Scholar 

  15. Cuschieri A, Flayers P, Fielding J, et al. 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.

    Article  PubMed  CAS  Google Scholar 

  16. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJH. Extended lymph-node dissection for gastric cancer.N Engl J Med 1999;340:908–14.

    Article  PubMed  CAS  Google Scholar 

  17. 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;79:1522–30.

    Article  PubMed  CAS  Google Scholar 

  18. Nakajima T, Nishi M. Surgery and adjuvant chemotherapy for gastric cancer.Hepatogastroenterology 1989;36:79–85.

    PubMed  CAS  Google Scholar 

  19. Nakajima T, Nashimoto A, Kitamura M, et al. Adjuvant mitomycin and fluorouracil followed by oral uracil plus tegafur in serosanegative gastric cancer: a randomized trial. Gastric Cancer Surgical Study Group.Lancet 1999;345:273–7.

    Article  Google Scholar 

  20. Okajima K. The long-term results of surgery for cancer. Stomach (in Japanese).Geka Shinryo 1976;18:868–72.

    Google Scholar 

  21. Nakatani K, Miyagi N, Takahashi S, Shiratori T, Konishi Y. Clinicopathological study of early gastric cancer (in Japanese).Nippon Shohkaki Geka Gakkai Zasshi 1979;12:597–603.

    Google Scholar 

  22. Yoshino K, Abe R, Saito H, et al. Lymph node metastasis of early gastric cancer. (in Japanese).Geka Shinryo 1979;21:1171–5.

    Google Scholar 

  23. Ishii T, Miura T, Harada T, et al. Clinical considerations in the surgical treatment for early gastric cancer (in Japanese).Nippon Shohkaki Geka Gakkai Zasshi 1981;14:39–44.

    Google Scholar 

  24. Kitoh T, Yamamura Y. Problems in the surgical treatment of early gastric cancer (in Japanese).Gann No Rinsyoh 1986;32:246–9.

    Google Scholar 

  25. Takeda J, Hashimoto K, Machi J, et al. Clinical and pathological evaluation of early gastric cancer and lymph node metastasis.Kurume Med J 1987;34:183–91.

    PubMed  CAS  Google Scholar 

  26. Inoue K, Tobe T. Surgical approach for early gastric cancer with special reference to lymph node metastasis (in Japanese).Shohkaki Geka 1986;9:291–7.

    Google Scholar 

  27. Matsushita M, Hachisuka K, Yamaguchi A, et al. A study on 11 cases of early gastric cancer with group 2 lymph node metastasis or more (in Japanese).Gann No Rinshoh 1988;34:1584–9.

    CAS  Google Scholar 

  28. Habu H, Takeshita K, Sasagawa M, Endo M. Lymph node metastasis in early gastric cancer.Int Surg 1986;71:244–7.

    PubMed  CAS  Google Scholar 

  29. Suzuki H, Kitamura Y, Sasagawa M, et al. A study of reasonable lymph node dissection for early gastric cancer (in Japanese).Geka Chiryo 1991;64:311–20.

    Google Scholar 

  30. Eriguchi M, Miyamoto Y, Fujii Y, et al. Regional lymph node metastasis of early gastric cancer.Eur J Surg 1991;157:197–200.

    PubMed  CAS  Google Scholar 

  31. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer.Br J Surg 1995;82:346–51.

    Article  PubMed  CAS  Google Scholar 

  32. Isozaki H, Okajima K, Ichinona T, et al. Distant lymph node metastasis of early gastric cancer.Surg Today 1997;27:600–5.

    Article  PubMed  CAS  Google Scholar 

  33. Baba H, Maehara Y, Takeuchi H, et al. Effect of lymph node dissection on the prognosis in patients with node-negative early gastric cancer.Surgery 1994;117:165–9.

    Article  Google Scholar 

  34. Endo M, Habu H. Clinical studies of early gastric cancer.Hepatogastroenterology 1990;37:408–10.

    PubMed  CAS  Google Scholar 

  35. Inoue K, Tobe T, Kan N, et al. Problems in the definition and treatment of early gastric cancer.Br J Surg 1991;78:818–21.

    Article  PubMed  CAS  Google Scholar 

  36. Maehara Y, Orita H, Okuyama T, et al. Predictors of lymph node metastasis in early gastric cancer.Br J Surg 1992;79:245–7.

    Article  PubMed  CAS  Google Scholar 

  37. Habu H, Takeshita K, Sunagawa M, Endo M. Prognostic factors of early gastric cancer—results of long-term follow-up and analysis of recurrent cases.Jpn J Surg 1987;17:248–55.

    Article  PubMed  CAS  Google Scholar 

  38. Moriguchi S, Odaka T, Hayashi Y, et al. Death due to recurrence following curative resection of early gastric cancer depends on age of the patients.Br J Cancer 1991;64:555–8.

    PubMed  CAS  Google Scholar 

  39. Seto Y, Nagawa H, Muto T. Prognostic significances of non-gastric malignancy after treatment of early gastric cancer.Br J Surg 1997;84:418–21.

    Article  PubMed  CAS  Google Scholar 

  40. Sano T, Sasako M, Kinoshita T, Maruyama K. Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature.Cancer 1993;72:418–21.

    Article  Google Scholar 

  41. Isozaki H, Tanaka N, Okajima K. General and specific prognostic factors of early gastric carcinoma treated with curative surgery.Hepatogastroenterology 1999;46:1800–8.

    PubMed  CAS  Google Scholar 

  42. Everett SM, Axon AT. Early gastric cancer in Europe.Gut 1997; 41:142–50.

    Article  PubMed  CAS  Google Scholar 

  43. Moreaux J, Bougaran J. Early gastric cancer: a 25-year surgical experience.Ann Surg 1993;217:347–55.

    Article  PubMed  CAS  Google Scholar 

  44. Noguchi Y, Yoshikawa T, Tsuburaya A, Motahashi H, Karpeh MS, Brennan MF. Is gastric carcinoma different between Japan and the United States?Cancer 2000;89:2237–46.

    Article  PubMed  CAS  Google Scholar 

  45. Schlemper RJ, Itabashi S, Kato Y, et al. Difference in diagnostic criteria for gastric carcinoma between Japanese and western pathologists.Lancet 1997;349:1725–9.

    Article  PubMed  CAS  Google Scholar 

  46. 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 metastasis.Br J Surg 1996;83:1144–7.

    Article  PubMed  CAS  Google Scholar 

  47. Ishida K, Katsuyama T, Sugiyama A, Kawasaki S. Immunohistochemical evaluation of lymph node micrometastasis from gastric carcinomas.Cancer 1997;79:1069–76.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asaki-Ku, 241, Yokohama, Japan

    Takaki Yoshikawa MD, PhD, Akira Tsuburaya MD, DMedSc, Osamu Kobayashi MD, DMedSc, Motonori Sairenji MD, DMedSc & Hisahiko Motohashi MD, DMedSc

  2. Department of Surgery, Yokohama Kowan Hospital, Yokohama, Japan

    Yoshikazu Noguchi MD, DMedSc

Authors
  1. Takaki Yoshikawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akira Tsuburaya MD, DMedSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osamu Kobayashi MD, DMedSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Motonori Sairenji MD, DMedSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hisahiko Motohashi MD, DMedSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshikazu Noguchi MD, DMedSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takaki Yoshikawa MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoshikawa, T., Tsuburaya, A., Kobayashi, O. et al. Is D2 lymph node dissection necessary for early gastric cancer?. Annals of Surgical Oncology 9, 401–405 (2002). https://doi.org/10.1007/BF02573876

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02573876

Key Words

Search

Navigation