D2 vs D2 Plus Para-aortic Lymph Node Dissection for Advanced Gastric Cancer
Mehmet Mahir Ozmen1,2,3
, Baris Zulfikaroglu3, Fusun Ozmen4,5, Munevver Moran2,3, Necdet Ozalp3, Selda Seckin6
1Department of Surgery, Medical School, Istinye University, Istanbul, Turkey
2General Surgery, Liv Hospital, Ankara, Turkey
3General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
4Department of Basic Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
5Medical Oncology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
6Pathology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
Abstract
Objective: Gastric cancer is a common malignancy worldwide. Effective treatment by interdisciplinary cooperation is important, and surgery still plays an important role.
Material and Methods: In a ten-year period, 355 patients were diagnosed to have gastric cancer. One hundred and sixty-two patients with a median (range) age of 58 (23-83) years were eligible for the study. There were 107 patients in D2 and 55 patients in D2 lymphadenectomy plus para-aortic lymph node (PALN) dissection group. The two groups were compared in terms of complications, morbidity, mortality and long-term survival.
Results: Length of stay was 12 (8-34) days for D2 and 14 (8-42) days for D2 plus PALND. Total number of operative mortality was 8/162 (5%), and it was not different between the groups. Twenty patients (18%) had complications in D2 group and 9 (17%) patients in D2 plus PALND group. Overall survival was also similar between the groups, but patients with T3-T4 tumors, patients with stage IIIA and IIIB disease had better survival with D2 plus PALN dissection. We found that the depth of invasion, PLN, ratio (PLN/TLN), stage and LND were all prognostic variables.
Conclusion: This study showed that D2 plus PALN dissection for advanced gastric cancer can be performed as safely as a standard D2 dissection by experienced surgeons without increasing postoperative morbidity and mortality. D2 plus PALN dissection should be preferred in the advanced stage of the disease (IIIA-IIIB) as it increases the rate of survival.
Keywords: Advanced gastric cancer, D2 lymphadenectomy, D2 lymphadenectomy plus para-aortic lymph node dissection, morbidity, mortality, prognosis
Ethics committee approval was obtained.
Externally peer-reviewed.
Concept - M.Ö.; Design - M.O., B.Z.; Supervision -M.Ö.; Materials - M.Ö., B.Z., N.Ö., M.M..; Data Collection and/or Processing - B.Z., N.Ö., F.Ö., M.M., S.S.; Analysis and Interpretation - M.Ö., F.Ö., B.Z.; Literature Review - M.Ö., B.Z.; Writing Manuscript - M.Ö., B.Z.; Critical Reviews - M.Ö.
The authors declare that they have no conflict of interest.
The authors declared that this study has received no financial support.