D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy

• Published in: World journal of surgical oncology 2013-02, Vol.11 (1), p.31-31, Article 31
• Main Authors: Shrikhande, Shailesh V, Barreto, Savio G, Talole, Sanjay D, Vinchurkar, Kumar, Annaiah, Somashekar, Suradkar, Kunal, Mehta, Shaesta, Goel, Mahesh
• Format: Article
• Language: English
• Subjects: Abdomen; Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adjuvant treatment; Adult; Aged; Cancer; Care and treatment; Chemotherapy; Comparative analysis; D2 lymphadenectomy; Disease; Epidemiology; Female; Gastrectomy; Gastric cancer; Gastrointestinal diseases; Health aspects; Hospitals; Humans; India; Lymph Node Excision - methods; Lymph nodes; Lymphatic Metastasis; Male; Medical imaging; Medical research; Medicine, Experimental; Metastasis; Methods; Middle Aged; Morbidity; Mortality; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Patient outcomes; Prospective Studies; Safety and security measures; Stomach cancer; Stomach Neoplasms - drug therapy; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Surgical outcomes; Tomography
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/1477-7819-11-31

Patients with locally advanced resectable gastric cancers are increasingly offered neoadjuvant chemotherapy (NACT) following the MAGIC and REAL-2 trials. However, information on the toxicity of NACT, its effects on perioperative surgical outcomes and tumor response is not widely reported in literature. Analysis of a prospective database of gastric cancer patients undergoing radical D2 gastrectomy over 2 years was performed. Chemotherapy-related toxicity, perioperative outcomes and histopathological responses to NACT were analyzed. The data is presented and compared to a cohort of patients undergoing upfront surgery in the same time period. In this study, 139 patients (42 female and 97 male patients, median age 53 years) with gastric adenocarcinoma received NACT. Chemotherapy-related toxicity was noted in 32% of patients. Of the 139 patients, 129 underwent gastrectomy with D2 lymphadenectomy, with 12% morbidity and no mortality. Major pathological response of primary tumor was noted in 22 patients (17%). Of these 22 patients, lymph node metastases were noted in 12 patients. The median blood loss and lymph node yield was not significantly different to the 62 patients who underwent upfront surgery. Patients who underwent upfront surgery were older (58 vs. 52 years, P