Improved regional control and survival with “low Maruyama Index” surgery in gastric cancer: autopsy findings from the Dutch D1-D2 Trial

Hundahl, Scott A.; Peeters, Koen; Kranenbarg, E. Klein; Hartgrink, Henk H.; Velde, Cornelis J.H. van de

doi:10.1007/s10120-007-0426-7

Cited by 32 publications

(22 citation statements)

References 11 publications

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“…Performing less than a D1 lymphadenectomy leaves even more positive lymph nodes behind. Hundahl et al [66] went on to define the Maruyama Index (MI) of unresected disease as the sum of the regional nodal disease (stations 1-12) percentages, as estimated by the Maruyama program, not removed by the surgeon. That study calculated the MI for 553 patients who enrolled in the Intergroup 0116 prospective, randomized trial of 5-FU-based chemoradiation versus surgery alone.…”

Section: Low Maruyama Index Surgerymentioning

confidence: 99%

Lymphadenectomy for Gastric Adenocarcinoma: Should West Meet East?

Yoon

Yang

2009

The Oncologist

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After completing this course, the reader will be able to:1. Calculate the lymph node drainage patterns of gastric adenocarcinoma based on the location of the tumor.2. Differentiate and explain the extent of lymphadenectomies performed in different countries.3. Analyze the risks and benefits of performing more extensive lymphadenectomies for gastric adenocarcinoma.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe extent of lymphadenectomy that should be performed for gastric adenocarcinoma has been a topic of persistent debate. In countries such as Japan and Korea, where the incidence of gastric adenocarcinoma is high, more extensive (e.g., D2) lymphadenectomies are routinely performed, usually by experienced surgeons with low morbidity and mortality. In western countries such as the U.S., where the incidence of gastric adenocarcinoma is tenfold lower, the performance of more extensive lymphadenectomies is generally limited to specialized centers, and quite possibly the majority of patients are treated at nonreferral centers with less than a D1 lymphadenectomy. There is little disagreement among gastric cancer experts that the minimum lymphadenectomy that should be performed for gastric adenocarcinoma should be at least a D1 lymphadenectomy. Two large, prospective randomized trials performed in the United Kingdom and the Netherlands failed to demonstrate a survival benefit of D2 over D1 lymphadenectomy, but these trials have been criticized for high surgical morbidity and mortality rates in the D2 group. More recent studies have demonstrated that western surgeons can be trained to perform D2 lymphadenectomies on western patients with low morbidity and mortality. Retrospective analyses and one prospective, randomized trial suggest that there may be some benefits to more extensive lymphadenectomies when performed safely, but this assertion requires further validation. This article provides an update on the current literature regarding the extent of lymphadenectomy for gastric adenocarcinoma.

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Section: Low Maruyama Index Surgerymentioning

confidence: 99%

Lymphadenectomy for Gastric Adenocarcinoma: Should West Meet East?

Yoon

Yang

2009

The Oncologist

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“…We read with interest the recent article by Hundahl et al entitled "Improved regional control and survival with 'low Maruyama Index' surgery in gastric cancer: autopsy fi ndings from the Dutch D1-D2 trial" [1], which further clarifi es and supports the use of adjuvant therapy. We were struck by the similarity between the 21% rate of locoregional failure (LRF) in the Maruyama Index (MI) ≥5 patients (reported in this article) to that of 23% reported in 1982 by Gunderson and Sosin [2].…”

Section: To the Editormentioning

confidence: 97%

Locoregional control remains a critical issue in gastric cancer

2008

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“…Hundahl's study, analysing survival curves and disease-specific survival rates, showed that MI <5 was an independent predictive factor of survival (25). The authors also reported data on 441 patients of the Dutch trial who subsequently died and were submitted to autopsy: 25 patients with MI <5 where found to have a lower incidence of local recurrence that those with MI ≥5 (8% vs. 21%, respectively) (25).…”

Section: The Maruyama Indexmentioning

confidence: 99%

“…The authors also reported data on 441 patients of the Dutch trial who subsequently died and were submitted to autopsy: 25 patients with MI <5 where found to have a lower incidence of local recurrence that those with MI ≥5 (8% vs. 21%, respectively) (25).…”

Section: The Maruyama Indexmentioning

confidence: 99%

Historical assumptions of lymphadenectomy

Morgagni¹,

Tringali²,

Barba³

et al. 2016

Transl. Gastroenterol. Hepatol.

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The role of lymphadenectomy for the treatment of gastric cancer is still very much open to debate. Consequently, Japanese, European and American surgeons perform different typologies of lymphadenectomy because of the absence of randomized clinical trials confirming the superiority of extended lymphadenectomy over less invasive surgery. In Japan, D2 lymphadenectomy has been considered as the gold standard for advanced gastric carcinoma for many years. Although numerous European studies have been conducted in an attempt to find differences between D1 and D2 lymphadenectomy, none has succeeded to date. The decision to wait for results attesting to the fact that D2 guarantees a better outcome than D1 resulted in a long delay in the implementation of D2 as the gold standard treatment in Europe. In the U.S., the study by Macdonald et al.

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Improved regional control and survival with “low Maruyama Index” surgery in gastric cancer: autopsy findings from the Dutch D1-D2 Trial

Cited by 32 publications

References 11 publications

Lymphadenectomy for Gastric Adenocarcinoma: Should West Meet East?

Lymphadenectomy for Gastric Adenocarcinoma: Should West Meet East?

Locoregional control remains a critical issue in gastric cancer

Historical assumptions of lymphadenectomy

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