D2 vs D2 Plus Para-aortic Lymph Node Dissection for Advanced Gastric Cancer
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
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 years period 355 patients were diagnosed to have gastric cancer. 162 patients with median (range) age of 58(23-83)years were eligible for study. There was 107 patients in D2 and 55 patients in D2 lymphadenectomy plus para-aortic lymph node (PALN) dissection group. Two groups were compared in terms of complications, morbidity, mortality and long-term survival.
Results: The duration of the stay was 12(8-34) days for D2 and 14(8-42) days for D2 plus PALN. The total number of operative mortality was 8/162 (5%) and it was not different between the groups. 20 patients (18%) had complications in D2 group and 9 (17%) patients in D2 plus PALN group. Overall survival was also similar between the groups but patients with T3-T4 tumors, patients with stage IIIA and IIIB disease and patients with higher ratio of PLN/TLN had better survival with D2 plus PALN dissection. We found that the depth of invasion, PLN, ratio (PLN/TLN), stage and LND were all independent prognostic variables.
Conclusion: This study has shown that D2 plus PALN dissection and 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 an advanced stage of the disease (IIIA-IIIB) as it increases the rate of survival.
Keywords: advanced gastric cancer, d2 lymphadenectomy, d2+paln lymphadenectomy, morbidity, mortality, prognosis