Comparison of Standard D2 and Limited Lymph Node Dissection in Elderly Patients with Advanced Gastric Cancer

• Published in: Annals of surgical oncology 2022-08, Vol.29 (8), p.5076-5082
• Main Authors: Ko, Chang Seok, Jheong, Jin Ho, Jeong, Seong-A., Kim, Byung Sik, Yook, Jeong Hwan, Yoo, Moon-Won, Kim, Beom Su, Lee, In-Seob, Kim, Sehee, Gong, Chung Sik
• Format: Article
• Language: English
• Subjects: Comorbidity; Dissection; Gastric cancer; Gastrointestinal Oncology; Lymph nodes; Lymphatic system; Medicine; Medicine & Public Health; Oncology; Statistical analysis; Surgery; Surgical Oncology; Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-022-11480-w

Background Knowledge on the optimal extent of lymphadenectomy among elderly patients with advanced gastric cancer is limited. This study was designed to compare standard D2 and limited lymphadenectomy for evaluating the appropriate extent of lymphadenectomy. Patients and Methods We retrospectively reviewed patient’s data based on a prospectively collected gastric cancer registry. The inclusion criteria were age above 75 years and histologically confirmed stage II or more advanced gastric cancer. In this study, 103 patients who underwent limited lymph node dissection and 134 patients who underwent standard D2 lymph node dissection were included to evaluate surgical and oncological outcomes using propensity score matching (PSM) analysis. Results The mean age after PSM was approximately 78 years in both groups. The Charlson Comorbidity Index was 5.81 ± 0.87 and 5.75 ± 0.76, respectively, and 12.5% of the patients in both groups had American Society of Anesthesiologists scores of more than 3. The limited lymphadenectomy group showed a shorter operation time and fewer retrieved lymph. However, other surgical outcomes and pathological data were not significantly different between the groups. No postoperative mortality within 30 days was observed. There were no significant differences in overall complications between the groups. The 3-year overall survival rates of the limited and standard lymphadenectomy groups were 58.3% and 73.6%, respectively. The 3-year recurrence-free survival rate of the limited lymphadenectomy group was lower than that of the standard lymphadenectomy group; however, the difference was not statistically significant. Conclusions Standard D2 lymphadenectomy has better oncological outcomes in elderly patients with advanced gastric cancer.