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Role of the Extended Lymphadenectomy in Gastric Cancer Surgery: Experience in a Single Institution

From the General Surgery Department, Clínica Universitaria, University of Navarra (AS, FMR, JLH-L, FP, JA-C), and Epidemiology (MAM-G), School of Medicine, University of Navarra, Pamplona, Spain.

Correspondence: Address correspondence and reprint requests to: A. Sierra, MD, General Surgery Department, Clínica Universitaria, University of Navarra, Avenida Pío XII, No. 36, 31008 Pamplona, Spain; Fax: 34-948-296500; E-mail: asierra{at}unav.es

Background: Although curative resection is the treatment of choice for gastric cancer, controversy exists about the adequate extent of lymph node dissection when resection is performed.

Methods: We retrospectively assessed 85 patients who underwent a limited lymphadenectomy (D1) and 71 who had an extended lymph node dissection (D2) in a single institution between 1990 and 1998 (median follow-up, 37.3 months). Prognostic factors were assessed by Cox proportional hazard models adjusted for potential confounders.

Results: We found no significant difference in the length of hospital stay (median, 12.1 and 13.1 days), overall morbidity (48.2% and 53.5%), or operative mortality (2.3% and 0%) between D1 and D2, respectively. Five-year survival in the D2 group was longer (50.6%) than in the D1 group (41.4%) for tumor stages (tumor-node-metastasis) >I. In multivariate analysis, tumor-node-metastasis stage (hazard ratio for stages >I vs. 0–I, 11.6), the ratio between invaded and removed lymph nodes, the presence of distant metastases, Laurén classification, and the extent of lymphadenectomy (hazard ratio for D1 vs. D2, 2.3; 95% confidence interval, 1.25–4.30) were the only significant prognostic factors.

Conclusions: Our experience shows that extended (D2) lymph node dissection improves survival in patients with resected gastric cancer.

Key Words: Extended • Lymphadenectomy • D2 • Gastric cancer

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