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Short-Term Outcome in Patients Undergoing Gastrectomy with D2 Lymphadenectomy for Carcinoma Stomach

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Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

The safety and feasibility of D2 lymphadenectomy for gastric cancer in Western patients have been shown by Italian Gastric Cancer Study Group (IGCSG). In our center at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), we have been doing D1 lymphadenectomy all these years. Hence, this study was taken up to assess the feasibility of gastrectomy with D2 lymphadenectomy in patients with gastric cancer at JIPMER, Puducherry, India. Of the 148 carcinoma stomach patients explored, a total of 52 patients (35.13%) underwent resection with D1 (34 patients) or D2 (18 patients) lymphadenectomy, who formed the study groups. Patients were admitted and investigated by upper gastrointestinal endoscopy (UGIE) and other appropriate investigations including contrast-enhanced computed tomography (CECT) of the abdomen. Eligible patients had no serious comorbid cardiorespiratory disease that would preclude a safe D2 procedure. Two-third of the patients in both the groups belonged to the 50–75 age group. The mean number of nodes dissected was 6.44 ± 5.3 in the gastrectomy with D1 lymphadenectomy group versus 21.67 ± 5.3 in the gastrectomy with D2 lymphadenectomy group. There was no difference in the intraoperative blood loss, the number of units of blood transfused and the duration of surgery between D1 and D2 lymphadenectomy in our study. There was no difference between the postoperative stay and overall stay between the D1 and D2 lymphadenectomy. There was no significant difference between the overall morbidity and mortality or when the surgical complications were analysed individually. Intraoperative blood loss, the number of units of blood required for transfusion and the duration of surgery were not increased in D2 lymphadenectomy. The number of lymph nodes harvested was significantly more in D2 lymphadenectomy that resulted in a better staging. Postoperative morbidity or mortality in patients undergoing D2 lymphadenectomy was the same as in D1 lymphadenectomy. Hence, gastrectomy with D2 lymphadenectomy could be done safely.

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References

  1. Ferlay J, Soerjomataram I, Ervik M et al. (2012) International Agency for Research on Cancer. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No.11

  2. D’Souza MA, Singh K, Shrikhande SV (2009) Surgery for gastric cancer: an evidence-based perspective. J Can Res Ther 5:225–231

    Article  Google Scholar 

  3. Sharma A, Radhakrishnan V (2011) Gastric cancer in India. Indian J Med Paediatr Oncol 32:12–16

    Article  PubMed  PubMed Central  Google Scholar 

  4. Okines A, Verheij M, Allum W, Cunningham D, Cervantes A (2010) Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol:v50–v54

  5. Toshifusa N (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5:1–5

    Google Scholar 

  6. Sasako M, Saka M, Fukagawa T, Katai H, Sano T (2006) Modern surgery for gastric cancer–Japanese perspective. Scand J Surg 95:232–235

    Article  CAS  PubMed  Google Scholar 

  7. Dikken JL, van de Velde CJH, Coit DG, Shah MA, Verheij M, Cats A (2012) Treatment of resectable gastric cancer. Ther Adv Gastroenterol 5:49–69

    Article  CAS  Google Scholar 

  8. Batista TP, Martins MR (2011) Lymph node dissection for gastric cancer: a critical review. Oncol Rev 6(12):95–100

    Google Scholar 

  9. Sue-Ling HM, Controversial topics in surgery (2006) Radical D2 gastrectomy for cancer. Ann R Coll Surg Engl 89:672–676

    Google Scholar 

  10. McCulloch P, Eidi Niita M, Kazi H, Gama-Rodrigues JJ (2005) Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer. Br J Surg 92:5–13

    Article  CAS  PubMed  Google Scholar 

  11. Mocellin S, McCulloch P, Kazi H, Gama‐Rodrigues J J, Yuan Y, & Nitti D (2015) Extent of lymph node dissection for adenocarcinoma of the stomach. The Cochrane Library

  12. Gunderson LL, Sosin H (1982) Adenocarcinoma of the stomach: areas of failure in a reoperation series (second or symptomatic look), clinico pathological correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 8:1

    Article  CAS  PubMed  Google Scholar 

  13. Degiuli M, Sasako M, Calgaro M, Garino M, Rebecchi F, Mineccia M, Scaglione D, Andreone D, Ponti A, Calvo F (2004) Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomized surgical trial. Eur J Surg Oncol 30:303–308

    Article  CAS  PubMed  Google Scholar 

  14. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  15. Noguchi M, Miyazaki I (1996) Prognostic significance and surgical management of lymph node metastasis in gastric cancer. Br J Surg 83:156–161

    Article  CAS  PubMed  Google Scholar 

  16. Takeda J, Koufuji K, Kodama I, Tsuji Y, Yokoyama T, Kawabata S, Suematsu T, Kakegawa T (1994) Total gastrectomy for gastric cancer: 12-year data and review of the effect of performing lymphadenectomy. Kurume Med J 41:15–21

    Article  CAS  PubMed  Google Scholar 

  17. Dent DM, Madden MV, Price SK (1988) Randomised comparison of R1 and R2 gastrectomy for gastric carcinoma. Br J Surg 75:110–112

    Article  CAS  PubMed  Google Scholar 

  18. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P (1996) Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The surgical cooperative group Lancet 347:995–999.

  19. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW (1995) Randomised comparison of morbidity after D1and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748

    Article  CAS  PubMed  Google Scholar 

  20. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340:908–914

    Article  CAS  PubMed  Google Scholar 

  21. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer 79:1522–1530

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, van Krieken JH, Meijer S, Plukker JT, van Elk PJ, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H, Sasako M (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22:2069–2077

    Article  CAS  PubMed  Google Scholar 

  23. Robertson CS, Chung SC, Woods SD, Griffin SM, Raimes SA, Lau JTF, Li AKC (1994) A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer. Ann Surg 220:176–182

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. McFadden DW, Mannal P (2013) Adenocarcinoma of the stomach, duodenum, and small intestine. In: Mc Fadden DW (ed) Shakelford’s Surgery of the Alimentary Tract, vol 2013, 7th edn. Elsevier Inc. Mayo Foundation, Philadelphia, pp 773–780

    Google Scholar 

  25. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1 D2 trial. Lancet Oncol 11:439–449

    Article  PubMed  Google Scholar 

  26. Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B (2011) Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg 253:900–911

    Article  PubMed  Google Scholar 

  27. Yang SH, Zhang YC, Yang KH, Li YP, He XD, Tian JH, Lv TH, Hui YH, Sharma N (2009) An evidence-based medicine review of lymphadenectomy extent for gastric cancer. Am J Surg 197:246–251

    Article  PubMed  Google Scholar 

  28. BuQiang W, GuangBin C, Jun Q (2009) Comparative study of complications after D1 and D2 gastrectomy for gastric cancer. Cancer Research and Clinic 21:95–97

    Google Scholar 

  29. Saka M, Morita S, Fukagawa T, Katai H (2011) Present and future status of gastric cancer surgery. Jpn J Clin Oncol 41:307–313

    Article  PubMed  Google Scholar 

  30. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, Lui WY, Whang-Peng J (2006) Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 7:309–315

    Article  CAS  PubMed  Google Scholar 

  31. Jiang L, Yang KH, Guan QL, Zhao P, Chen Y, Tian JH (2013) Survival and recurrence free benefits with different lymphadenectomy for resectable gastric cancer: a meta-analysis. J Surg Oncol 107:807–814

    Article  PubMed  Google Scholar 

  32. Eom BW, Joo J, Kim YW, Park B, Park JY, Yoon HM, Lee JH, Ryu KW (2013) Is there any role of additional retropancreatic lymph node dissection on D2 gastrectomy for advanced gastric cancer? Ann Surg Oncol 20:2669–2675

    Article  PubMed  Google Scholar 

  33. Edwards P, Blackshaw GRJC, Lewis WG, Barry JD, Allison MC, Jones DRB (2004) Prospective comparison of D1 vs. modified D2 gastrectomy for carcinoma. Br J Cancer 90:1888–1892

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Degiuli M, Sasako M, Ponti A (2010) Morbidity and mortality in the Italian Gastric Cancer study group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 97:643–649

    Article  CAS  PubMed  Google Scholar 

  35. Pacelli F, Doglietto GB, Bellantone R, Alfieri S, Sgadari A, Crucitti F (1993) Extensive versus limited lymph node dissection for gastric cancer: a comparative study of 320 patients. Br J Surg 80:1153–1156

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Ganesh Vadthya, Vishnu Prasad Nelamangala Ramakrishnaiah & Srinivasan Krishnamachari

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  1. Ganesh Vadthya
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  2. Vishnu Prasad Nelamangala Ramakrishnaiah
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  3. Srinivasan Krishnamachari
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Correspondence to Ganesh Vadthya.

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Vadthya, G., Ramakrishnaiah, V.P.N. & Krishnamachari, S. Short-Term Outcome in Patients Undergoing Gastrectomy with D2 Lymphadenectomy for Carcinoma Stomach. Indian J Surg Oncol 8, 304–311 (2017). https://doi.org/10.1007/s13193-017-0620-y

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