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

Abstract

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...

Lymph node ratio is a better prognosticator than lymph node status for gastric cancer: A retrospective study of 138 cases

“…In routine clinical practice, LN resection in GC patients is generally not up to D2 lymphadenectomy standard, despite D2 lymphadenectomy being regarded as the standard surgical technique in Eastern Asian countries ( 21 , 22 ). Certain studies did not consider this factor in the inclusion criteria ( 17 , 23 , 27 , 30 ), weakening the credibility of the results.…”

Long term follow up and retrospective study on 533 gastric cancer cases

“…Surgical procedures have a big impact on OS and recurrence [10]. R0 resection with D2 lymphadenectomy is regarded as the standard surgical technique [11,12], as D2 lymphadenectomy had lower recurrence and GC-related death rates [13]. However, for stage III and beyond patients, the currently adopted surgical procedure only removes local tumor mass but often neglects the micro-metastases.…”

Impact of lymph node ratio in selecting patients with resected gastric cancer for adjuvant therapy

“…While resection provides the best chance at cure, recurrence is common, and therefore, longterm cure can be difficult to achieve. 1,8,30 Recurrence can range widely from 5% to 90% depending on the stage of the disease, and patterns of recurrence can be varied (e.g. locoregional, hematogenous, peritoneal).…”