Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study

The survival benefit of extended lymphadenectomy in the surgical treatment of gastric cancer is still being debated. The aim of this longitudinal multicenter study was to evaluate long-term survival in a group of patients with involvement of second level lymph nodes, which would not have been remove...

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Bibliographic Details
Published in:Annals of surgical oncology 2002-11, Vol.9 (9), p.894-900
Main Authors: Roviello, Franco, Marrelli, Daniele, Morgagni, Paolo, de Manzoni, Giovanni, Di Leo, Alberto, Vindigni, Carla, Saragoni, Luca, Tomezzoli, Anna, Kurihara, Hayato
Format: Article
Language:English
Subjects:
Adenocarcinoma - mortality
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Female
Gastrectomy - adverse effects
Gastrectomy - methods
Gastric cancer
Humans
Longitudinal Studies
Lymph Node Excision - adverse effects
Lymph nodes
Lymphatic Metastasis
Lymphatic system
Male
Medical prognosis
Metastases
Metastasis
Middle Aged
Morbidity
Mortality
Multivariate Analysis
Patients
Proportional Hazards Models
Stomach Neoplasms - mortality
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Survival
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Summary:The survival benefit of extended lymphadenectomy in the surgical treatment of gastric cancer is still being debated. The aim of this longitudinal multicenter study was to evaluate long-term survival in a group of patients with involvement of second level lymph nodes, which would not have been removed in the case of a limited lymphadenectomy. Results were compared with those in patients with involvement of first level lymph nodes. Between 1991 and 1997, 451 patients with primary gastric cancer underwent curative resection with extended lymphadenectomy at three surgical departments in Italy according to the rules of the Japanese Research Society for Gastric Cancer. In 451 cases treated by extended lymphadenectomy, morbidity and mortality rates were 17.1% and 2%, respectively. In 126 patients (27.9%) (group A), metastases were found in lymph node stations 7 to 12; 109 patients (24.2%) had metastases confined to the first level (group B). Lymph node stations 7 and 8 showed the highest incidence of metastases in the second level (17.1% and 12.4%, respectively). A significant difference in 5-year survival was observed between group A and group B (32% vs. 54%; P =.0005). This difference disappeared when cases were stratified according to the number of positive lymph nodes. By multivariate analysis, only the number of positive lymph nodes (relative risk, 1.8; P
ISSN:1068-9265
1534-4681
DOI:10.1007/BF02557527