Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden

• Published in: Chinese journal of cancer research 2017-08, Vol.29 (4), p.313-322
• Main Authors: Kung, Chih-Han, Song, Huan, Ye, Weimin, Nilsson, Magnus, Johansson, Jan, Rouvelas, Ioannis, Irino, Tomoyuki, Lundell, Lars, Tsai, Jon A, Lindblad, Mats
• Format: Article
• Language: English
• Subjects: Cancer and Oncology; Cancer och onkologi; Clinical Medicine; Complications; Gastric cancer; Klinisk medicin; logistic回归分析; Lymphadenectomy; Medical and Health Sciences; Medicin och hälsovetenskap; Mortality; National database; Original; 并发症; 手术切除; 死亡率; 淋巴结; 瑞典; 胃癌; 随机对照试验
• ISSN: 1000-9604; 1993-0631
• DOI: 10.21147/j.issn.1000-9604.2017.04.04

Objective： Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990＇s reported increased morbidity and mortality for D2 compared to D 1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods： A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into DO, D I, or D I ＋/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results： In total, 349 （31.7%） patients had a DO, 494 （44.9%） DI, and 258 （23.4%） DI＋/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5%, 25.1% and 32.2 % （DO, D I and D1 ＋/D2, respectively）, and 90-d mortality rates were 8.3%, 4.3 % and 5.8%. After adjustment for confounders, in mukivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. DO. Conclusions： The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy （DO and DI）. More extensive lymphadenectomy （DI＋/D2） seemed to have no impact on postoperative morbidity or mortality.