The results of D1 versus D2 dissection in the management of gastric cancer was evaluated retrospectively for morbidity and mortality
Bülent Cavit Yüksel, Nilay S Uçar, Yiğit Yıldız, Hüseyin Berkem, Hakan Özel, Süleyman Hengirmen
S.B. Ankara Numune Eğitim ve Araştırma Hastanesi, Genel Cerrahi, Ankara, Türkiye
Purpose: The chance to get healing in stomach cancer is possible with curative surgical resection. In this study we aimed to analyze the mortality and morbidity rates between D1 dissection and D2 dissection retrospectively.
Materials and Methods: Between 2000 and 2009, 112 patients with gastric cancer who underwent D1 or D2 dissection were evaluated retrospectively. Surgery procedure and pathological classification were performed in accordance with the Japanese Classification of Gastric Carcinoma. The postoperative mortality and morbidity were analysed retrospectively.
Results: In our clinic, the data of 131 patients, who had the diagnosis of gastric carcinoma, were reviewed retrospectively. 112 patients who fitted to the criteria of this study were included. Of the 112 patients, 47 went under D1 dissection, while 67 patients went under D2 resection. The overall operative mortality rates for D1 and D2 dissections were 2,1 and 0 %, respectively (p>0.05). Patients who underwent D2 dissection had significantly longer median operation time, more blood loss and more transfusion required in comparison to patients who underwent D1 dissection. The overall morbidity associated with surgery is found to be at a rate of 15,1 %. There was no significant difference between the two groups with regard to the major complications. However, when minor complications were assesed, a significant increase in the D2 group was observed. The overall mortality rate was calculated as 0.89 %.
Conclusion: In our study, although extensive dissection had an increased morbidity, there was no significant statistical difference between the two procedures. As a conclusion, we think that D2 dissection can be carried out with safety in centers with experience.
Keywords: Gastric cancer, lymph node dissection, gastric resection, gastrectomy