D2 or not D2? The gastrectomy question

Lewis, Wyn G.; Edwards, Paul A.W.; Barry, Jonathan; Khan, Saboor; Dhariwal, Daljit; Hodzovic, I.; Allison, M. E. M.; Shute, K

doi:10.1007/s101200200004

Cited by 42 publications

(37 citation statements)

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“…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%

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

et al. 2008

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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...

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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].…”

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

et al. 2008

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“…Additionally, Western centers that have adopted working systems of this type and have recognized the learning curve for the D2 lymphadenectomy have shown great improvement in their results, which are similar to those of the Japanese studies; for example, Lewis et al [22] found that surgical subspecialization reduced operative mortality from 12% to 3.1% over a period of 5 years.…”

Section: Discussionmentioning

confidence: 54%

Results of specialization in the surgical treatment of gastric cancer in Peru

et al. 2007

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“…All patients were staged by means of computed tomography of the thorax and abdomen, supplemented with laparoscopy for those patients deemed potential surgical candidates. A modifi ed D2 resection (preserving pancreas and spleen where possible) was the operation of choice [10,11]. Patients were staged according to the unifi ed TNM classifi cation of gastric cancer [12,13].…”

Section: Methodsmentioning

confidence: 99%

Prognostic significance of gastrin expression in patients undergoing R0 gastrectomy for adenocarcinoma

et al. 2007

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D2 or not D2? The gastrectomy question

Abstract: Modified D2 gastrectomy without pancreatico-splenectomy, performed by specialist surgeons, can improve survival after R0 resections without increasing operative morbidity and mortality, when compared with D1 gastrectomy performed by general surgeons.

Cited by 42 publications

References 12 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

Results of specialization in the surgical treatment of gastric cancer in Peru

Prognostic significance of gastrin expression in patients undergoing R0 gastrectomy for adenocarcinoma

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