A critical evaluation of effectivity of extended lymphadenectomy in patients with carcinoma of the stomach

Abstract

The therapeutic benefit of extended lymphadenectomy in patients with gastric cancer is not generally accepted. We therefore analyzed the data of 82 patients with total gastrectomy and extended lymphadenectomy (compartment I: lymph nodes 1-6 and compartment II: lymph nodes 7-11) from 1979 to 1986 (GL group) for morbidity, mortality and survival and compared these with the results of a historical control group of 81 patients from 1971 to 1986 (group G), who similarly had undergone total gastrectomy but only compartment-I lymphadenectomy (lymph nodes 1-6). The 30-day operative mortality in the GL group was 6% (5/82), which was no higher than that of the control group (9.5%, 4/42) during the same observation period (1979-1986). The comparison of the actuarial survival according to the old TNM system (UICC 1978) in both groups showed no significant differences: stages I and II P = 0.22, stage III P = 0.29, all curative cases (stages I+II+III) P = 0.12. In addition, the patients of the GL group were restaged according to the new TNM system (UICC 1987). The calculated 5-year survival rate in this group was: stage I, 89%; stage II, 64%; stage III, 21%; curative total (stages I+II+III), 62%; stage IV, 0%. All patients (n = 12) with involvement and dissection of lymph nodes of compartment II died within 38 months. Only two of these patients (17%) had a potentially curative operation. Our results indicate that compartment-II lymph node dissection did not influence the operative mortality or the prognosis compared with compartment-I lymphadenectomy. Since patients with positive lymph nodes in compartment II did not benefit from the extended lymph node dissection of this area, obviously because of systemic spread, the question of the effectiveness of the extended lymphadenectomy remains unresolved.

Pathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: A prospective with quality control 10-year follow-up study

“…We conducted this study in order to assess the potential of a Japanese-type radical surgery in Western patients. Because experience and pancreas preservation are predominant factors for both the safety and completeness of an extended lymph node dissection (Siewert et al, 1998;Brennan, 1999;Roukos, 2000b), we started this study after gaining 7 years experience with D2 dissection (Roukos et al, 1990). This strategy and the low rate of pancreatectomies explains the low rate of in-hospital mortality (1.6%) in our study, which is similar to that of other reports (Marujama et al, 1987;Siewert et al, 1998;Fujii et al, 1999;Kim, 1999) suggesting the safety of the D2 procedure when the criteria of a surgeon's experience and pancreas-preserving technique are met.…”

Role of the Extended Lymphadenectomy in Gastric Cancer Surgery: Experience in a Single Institution

“…Changes in recruitment were due to skepticism about EL results reported in different published series. [10][11][12] We included resectable patients with any tumor stage (1997 tumor-node-metastasis classification 13 ), except for those with macroscopic distant metastases (bone, hepatic, lung, or peritoneal) and any location, excluding esophageal tumors, affecting the stomach. Patients with positive peritoneal lavage (two cases in D1 and four cases in D2), affected hepatoduodenal lymph nodes, or localized carcinomatosis at the bursa omentalis (one patient in the D2 group) were also included.…”

Outcomes of breast cancer patients with and without BRCA1/2 mutations

“…14 Generally, local control with appropriate surgery alone or plus radiotherapy is important for clinical outcomes not only for breast cancer [12][13][14] but also for various cancer types including early-stage gastric tumors. 15,16 Improved survival rates can be achieved with adequate extensive surgery [17][18][19][20][21] or limited surgery plus chemoradiation. 22,23 A complete resection (R0) of the primary tumor still remains the standard treatment for localized solid tumors despite the availability of effective adjuvant chemoradiotherapy.…”