Complications of gastrectomy with lymphadenectomy in gastric cancer

Zilberstein, Bruno; Martins, Bruno Costa; Jacob, Carlos Eduardo; Bresciani, Claudio; Lopasso, Fabio Pinatel; Cleva, Roberto de; Pinto, Paulo Engler; Ribeiro, Ulysses; Perez, Rodrigo Oliva; Gama-Rodrigues, Joaquim

doi:10.1007/s10120-004-0301-8

Cited by 31 publications

(29 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The overall incidence of dehiscence in our series (3.2%) included not only esophagojejunal anastomotic dehiscences but also all other anastomotic and suture dehiscences. Most sources in the literature do not provide details on the incidence of esophagojejunal anastomotic leakage, which reached 1.6% in our series -in agreement with the fi ndings of other studies that have published such information [12,23].…”

Section: Resultssupporting

confidence: 89%

“…We consider this fi gure to be reasonable, because it includes all the recorded complications, and is lower than the percentages reported by other authors [2,3,5,6,22], though some series have yielded overall morbidity rates of under 12% [7,23,24]. The most common nonabdominal complications in our series were of a respiratory nature, in agreement with many other literature sources [3,[7][8][9][10][11][12][13][14][22][23][24].…”

Section: Resultssupporting

confidence: 85%

“…This and the publication of studies showing the advantages of D2 lymphadenectomy have generated uncertainty regarding an ideal lymphadenectomy for the management of these patients [4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer

et al. 2008

View full text Add to dashboard Cite

a marked improvement in survival (between 50% and 62%), largely attributed to lymph node resection known as "D2 lymphadenectomy" [1]. The randomized prospective studies made by the Dutch Gastric Cancer Group and the Medical Research Council, comparing patients submitted to D2 lymphadenectomy with those submitted to D1 gastrectomy, concluded that D2 lymphadenectomy caused greater morbidity and mortality, without benefi t in terms of survival. The procedure therefore was not recommended on a routine basis [2,3].These conclusions have been repeatedly questioned, however, for methodological reasons, among others. This and the publication of studies showing the advantages of D2 lymphadenectomy have generated uncertainty regarding an ideal lymphadenectomy for the management of these patients [4][5][6][7][8][9][10][11][12][13][14][15][16][17].Moreover, other studies suggest that surgeon expertise not only plays an important role in reducing surgical morbidity and mortality but also contributes substantially to improving survival [18].Gastric cancer mortality is largely attributable to relapse of the disease, manifesting in different ways or in more than one location simultaneously [19].Some authors consider gastric cancer relapse and patient survival to depend on both the stage of the disease at the time of diagnosis and on the extent of surgery [4].The present study examined whether D2 lymphadenectomy associated with surgery for gastric cancer can be performed with morbidity and mortality outcomes that justify the procedure, and, moreover, whether the procedure offers benefi t in terms of patient survival.The study presents the results obtained with gastrectomy and D2 lymphadenectomy performed over a period of time at the Department of General and Digestive Surgery (Esophagogastric Unit) of the Virgen del Camino Hospital (Pamplona, Navarre, Spain). AbstractBackground. 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 fi rst 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 classifi cation 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 benefi t in terms of survival for a certain percentage of patients with positive level N2...

show abstract

Section: Resultssupporting

confidence: 89%

Section: Resultssupporting

confidence: 85%

See 1 more Smart Citation

Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer

et al. 2008

View full text Add to dashboard Cite

show abstract

“…A lower recurrence rate was observed in cases with higher total LNs, indicating that a sufficient lymphadenectomy contributed to reduce the number of residual tumor cells. While correlating the number of dissected LNs with the post-operative complication rate, Zilberstein et al [24] did not find any difference between the average number of dissected LNs in patients with and without complications. These authors suggested that the higher morbidity and mortality rates were not due to the extended lymphadenectomy.…”

Section: Discussionmentioning

confidence: 93%

Prognostic impact of dissected lymph node count on patients with node-negative gastric cancer

Huang¹,

Lin²,

Zheng³

et al. 2009

WJG

View full text Add to dashboard Cite

AIM:To investigate the long-term effect of the number of resected lymph nodes (LNs) on the prognosis of patients with node-negative gastric cancer. METHODS:Clinical data of 211 patients with gastric cancer, without nodal involvement, were analyzed retrospectively after D2 radical operation. We analyzed the relationship between the number of resected LNs with the 5-year survival, the recurrence rate and the post-operative complication rate. RESULTS:The 5-year survival of the entire cohort was 82.2%. The total number of dissected LNs was one of the independent prognostic factors. Among patients with comparable depth of invasion, the larger the number of resected LNs, the better the survival (P < 0.05). A cut-point analysis provided the possibility to detect a significant survival difference among subgroups. Patients had a better long-term survival outcomes with LN counts ≥ 15 for pT1-2, ≥ 20 for pT3-4, and ≥ 15 for the entire cohort. The overall recurrence rate was 29.4% within 5 years after surgery. There was a statistically significant, negative correlation between the number of resected LNs and the recurrence rate (P < 0.01). The post-operative complication rate was 10.9% and was not significantly correlated with the number of dissected LNs (P > 0.05). CONCLUSION:For node-negative gastric cancer, sufficient number of dissected LNs is recommended during D2 lymphadenectomy, to improve the long-term survival and reduce the recurrence. Suitable increments of the dissected LN count would not increase the postoperative complication rate.

show abstract

“…Subsequent studies have supported this procedure-related safety. Several nonrandomized trials have also demonstrated no differences in morbidity and mortality between a D1 and a D2 or wider LND (Bösing et al, 2000;Edwards et al, 2004;Danielson et al, 2007;Zilberstein et al, 2004). The RCTs conducted in the dedicated centers in the West elucidated a safer performance with a D2 or wider LND, with morbidity and hospital mortality being 17-22% and <2%, respectively, if resection of the pancreas and/or spleen was performed for selected patients.…”

Section: Adjuvant Settingmentioning

confidence: 99%

Multimodal Therapies for Upper Gastrointestinal Cancers – Past, Now, and Future

Shimoyama¹

2011

Current Cancer Treatment - Novel Beyond Conventional Approaches

View full text Add to dashboard Cite

Complications of gastrectomy with lymphadenectomy in gastric cancer

Cited by 31 publications

References 15 publications

Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer

Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer

Prognostic impact of dissected lymph node count on patients with node-negative gastric cancer

Multimodal Therapies for Upper Gastrointestinal Cancers – Past, Now, and Future

Contact Info

Product

Resources

About