Abstract
Background
In the surgical management of gastric cancer, D2 lymphadenectomy aims to reduce the incidence of locoregional relapse, and to increase patient survival.
Methods
A prospective study was made of 126 consecutive patients operated upon for gastric cancer, with gastrectomy and D2 lymphadenectomy. Hospital morbidity and mortality, relapses, and patient survival after 5 years were studied.
Results
The overall hospital mortality rate was 1.6%, with a mortality of 2.1% in the patients submitted to total gastrectomy. The overall morbidity rate was 29.4%. Dehiscence of the esophagojejunal anastomosis was recorded in 1.6%. The median follow-up was 73.6 months. Relapses were observed in 37% of the patients (76% in the first 2 years). Overall actuarial survival after 5 years was 52.3%, and 5-year survival in the patients with R0 resection with positive N2 lymph nodes according to the Japanese classification was 26.5%.
Conclusion
Our results show that D2 lymphadenectomy can be performed with low morbidity-mortality, and a 5-year survival of more than 50%. The procedure offers benefit in terms of survival for a certain percentage of patients with positive level N2 lymph nodes.
Article PDF
Similar content being viewed by others
References
Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric adenocarcinoma: review and considerations for future directions. Ann Surg 2005;241:27–39.
Bonenkamp J, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999;340:908–914.
Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, 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;347:995–999.
Roukos D, Kappas A. Limitations in controlling risk for recurrence after curative surgery for advanced gastric cancer are now well explained by molecular-based mechanisms. Ann Surg Oncol 2001;8:620–621.
Desai A, Pareek M, Nightingale P, Fielding J. Improving outcomes in gastric cancer over 20 years. Gastric Cancer 2004;7:196–203.
Sasako M. Risk factors for surgical treatment in the Dutch gastric cancer trial. Br J Surg 1997;84:1567–1571.
Roviello F, Marrelli D, Morgagni P, de Manzoni G, Di Leo A, Vindigni C, et al. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study. Ann Surg 2002;9:894–900.
Siewert JR, Böttcher K, Stein H, Roder JD. Relevant prognostic factors in gastric cancer: 10-year results of the German Gastric Cancer Study. Ann Surg 1998;228:449–461.
Siewert JR, Böttcher K, Roder JD, Busch R, Heimanek P, Meyer HJ. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. Br J Surg 1993;80:1015–1018.
Csendes A, Burdiles P, Rojas J, Braghetto I, Diaz JC, Maluenda F. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery 2002;131:401–407.
Bittner R, Butters M, Ulrich M, Uppenbrink S, Beger HG. Total gastrectomy: updated operative mortality and long-term survival with particular reference to patients older than 70 years of age. Ann Surg 1996;224:37–42.
Zilberstein B, da Costa Martins B, Jacob CE, Bresciani C, Lopasso FP, de Cleva R, et al. Complications of gastrectomy with lymphadenectomy in gastric cancer. Gastric Cancer 2004;7:254–259.
Lewis WG, Edwards P, Barry JD, Khan S, Dhariwal D, Hodzovic I, et al. D2 or not D2? The gastrectomy question. Gastric Cancer 2002;5:29–34.
Roder JD, Böttcher K, Siewert JR, Busch R, Hermanek P, Meyer HJ. Prognostic factors in gastric carcinoma. Results of the German Gastric Carcinoma Study 1992. Cancer 1993;72:2089–2097.
Roukos D, Lorentz M, Encke A. Evidence of survival benefit of extended (D2) lymphadenectomy in Western patients with gastric cancer based on a new concept: a prospective long-term follow-up study. Surgery 1998;123:573–578.
Kappas A, Roukos D. Quality of surgery determinant for the outcome of patients with gastric cancer. Ann Surg Oncol 2002;9:828–830.
Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch Gastric Cancer Group trial. J Clin Oncol 2004;22:2069–2077.
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in United States. N Engl J Med 2003;349:2117–2127.
Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma. Br J Surg 2000;87:236–242.
Wittekind CH, Greene FL, Hutter RVP, Klimpfinger M, Sobin LH, editors. TNM atlas: illustrated guide to the TNM classification of malignant tumors. 5th ed. Heidelberg Berlin New York Tokyo: Springer; 2005.
Díaz de Liaño A, Ciga MA, Oteiza F, Aizcorbe M, Cobo F, Trujillo R. Factors involved in morbidity and mortality of total gastrectomy for gastric cancer. Rev Oncol 2002;4:265–270.
Dent D, Madden M, Price S. Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma. Br J Surg 1988;75:110–112.
Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Crose N, et al. Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial. Ann Surg 1997;226:613–620.
Sano T, Katai H, Sasako M, Maruyama K. One thousand consecutive gastrectomies without operative mortality. Br J Surg 2002;89:123.
Martin R, Jaques D, Brennan M, Karpeh M. Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg 2002;236:159–165.
Kodera Y, Yamamura Y, Shimizu Y, Torii A, Hirai T, Yasui K, et al. Lack of benefit of combined pancreaticosplenectomy in D2 resection for proximal-third gastric carcinoma. World J Surg 1997;21:622–628.
Maehara Y, Hasuda S, Koga T, Tokunaga E, Kakeji Y, Sugimachi K. Postoperative outcome and sites of recurrence in patients following curative resection of gastric cancer. Br J Surg 2000;87:353–357.
Böhner H, Zimmer T, Hopfenmüller W, Berger G, Buhr HJ. Detection and prognosis of recurrent gastric cancer. Is routine follow-up after gastrectomy worthwhile? Hepatogastroenterology 2000;47:1489–1494.
D’Angelica M, Gonen M, Brennan MF, Turnbull AD, Bains M, Karpeh MS. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg 2004;240:808–816.
Schwarz R, Zagala-Nevarez K. Recurrence patterns after radical gastrectomy for gastric cancer: factors and implications for postoperative adjuvant therapy. Ann Surg Oncol 2002;9:394–400.
Bennett JJ, Gonen M, D’Angelica M, Jaques DP, Brennan MF, Coit DG. Is detection of asymptomatic recurrence after curative resection associated with improved survival in patients with gastric cancer? J Am Coll Surg 2005;201:503–510.
Marrelli D, Roviello F, de Manzoni G, Morgagni P, Di Leo A, Saragoni L, et al. Different patterns of recurrence in gastric cancer depending on Lauren’s histological type: longitudinal study. World J Surg 2002;26:1160–1165.
Marrelli D, De Stefano A, de Manzoni G, Morgagni P, Di Leo A, Roviello F. Prediction of recurrence after radical surgery for gastric cancer. A scoring system obtained from a prospective multicenter study. Ann Surg 2005;241:247–255.
Averbach A, Jacquet P. Strategies to decrease the incidence of intra-abdominal recurrence in resectable gastric cancer. Br J Surg 1996;83:726–733.
Shchepotin I, Evans SR, Shabahang M, Cherny V, Buras RR, Zadorozhny A, et al. Radical treatment of locally recurrent gastric cancer. Am Surg 1995;61:371–376.
Karpeh M, Leon L, Klimstra D, Brennan M. Lymph node staging in gastric cancer: is location more important than number? An analysis of 1038 patients. Ann Surg 2000;232:362–371.
Rosenberg R, Nekarda H, Bauer P, Schenck U, Hoefler H, Siewert JR. Free peritoneal tumour cells are an independent prognostic factor in curatively resected stage IB gastric carcinoma. Br J Surg 2006;93:325–331.
Oka M, Yoshino S, Hazama S, Shimoda K, Suzuki M, Suzuki T. Prognosis significance of regional lymph node reaction after curative resection of advanced gastric cancer. Br J Surg 1992;79:1091–1094.
Kranenbarg E, Hermans J, van Krieken J, Van de Velde C. Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value. Br J Cancer 2001;84:64–71.
Roukos D, Paraschou P. Extended lymph-node dissection in gastric cancer: standard, selective or unnecessary procedure? Hepatogastroenterology 2000;47:904–906.
Seto Y, Nagawa H, Muto T. Results of extended lymph node dissection for gastric cancer cases with N2 lymph node metastasis. Int Surg 1997;82:257–261.
Fujii M, Sasaki J, Nakajima T. State of the art in the treatment of gastric cancer: from the 71st Japanese Gastric Cancer Congress. Gastric Cancer 1999;2:151–157.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Díaz De Liaño, Á., Yarnoz, C., Aguilar, R. et al. Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer. Gastric Cancer 11, 96–102 (2008). https://doi.org/10.1007/s10120-008-0460-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10120-008-0460-0