IMPORTANCE OF EXTENDED LYMPH NODE DISSECTION IN GASTRIC CANCER

Abstract

Gastric cancer is the second most important malignant disorder for the causes of tumor related death in the general population. Curative treatment for gastric carcinoma is surgery and the goal of surgical therapy is complete removal of the tumor. The extent of the lymphadenectomy must also be taken into account by the surgeon because it also has direct impact on achieving complete tumor removal. Extended lymph node dissection for gastric cancer is a standard part of the surgery in Japan, although some authors in western countries claim that lymphadenectomy is not effective to improve survival. Between 1995 and 1998, DO-D1 lymphadenectomy for 14 patients and D2lymphadenectomy for 16 patients were performed for gastric carcinoma in GMMA General Surgery Department. Patients were evaluated according to positive or negative resection margins, lymphatic and perineural invasion, number of the metastatic lymph nodes and stage of gastric cancer. The effects of the lymphadenectomy type to 3 year survival rates were analysed. Mean follow-uptimes were 19.21 ± 8.51 months for DO-D1 lymphadenectomies and 18.75±8.18 months for D2 lymphadenectomies. Tumor sizes, depth of the tumor invasion, lymphatic and perineural invasion and stage of cancer have been found the most important prognostic factors in both two groups. D2lymphadenectomy (74.07%) has better 3 year survival rates than DO-D1 lymphadenectomy (40%). As a result, extended lymph node dissection gives better prognostic and therapeutic results for the radical surgical treatment of gastric cancer.