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10.1245/ASO.2006.07.015
Annals of Surgical Oncology 13:659-667 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Comparison of Surgical Results of D2 Versus D3 Gastrectomy (Para-Aortic Lymph Node Dissection) for Advanced Gastric Carcinoma: A Multi-Institutional Study

Chikara Kunisaki, MD, PhD1, Hirotoshi Akiyama, MD, PhD1, Masato Nomura, MD, PhD1, Goro Matsuda, MD, PhD1, Yuichi Otsuka, MD, PhD1, Hidetaka Ono, MD, PhD1, Yutaka Nagahori, MD, PhD2, Hideo Hosoi, MD, PhD2, Masazumi Takahashi, MD, PhD3, Fumihiko Kito, MD, PhD3 and Hiroshi Shimada, MD, PhD1

1 Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3–9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
2 Department of Surgery, Yokosuka Kyosai Hospital, 1–16 Yonegahamadori, Yokosuka 238-0011, Japan
3 Department of Surgery, Yokohama Municipal Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama 240-0062, Japan

Correspondence: Address correspondence and reprint requests to: Chikara Kunisaki, MD, PhD; E-mail: s0714{at}med.yokohama-cu.ac.jp

Background: Curative gastrectomy is a promising approach for the treatment of gastric cancer; however, the optimal extent of lymph node dissection for advanced cancer remains controversial. The aim of this multi-institutional study was to evaluate the feasibility of D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric cancer. The surgical results of D2 and D3 gastrectomy (para-aortic lymph node dissection) were retrospectively compared.

Methods: A series of 580 advanced gastric cancer patients were registered between 1992 and 2000. Of these, 430 underwent D2 gastrectomy and 150 underwent D3 gastrectomy. Survival time, prognostic factors, postoperative morbidity/mortality, and pattern of recurrence were compared.

Results: There was no significant difference in survival time between D2 and D3 patients. However, the survival times of D3 patients with tumor diameters measuring 50 to 100 mm or with pN1 disease were significantly longer than those of the corresponding D2 patients. Analysis of the survival of patients with tumor diameters measuring 50 to 100 mm revealed that D3 gastrectomy conferred a survival advantage only to patients with pN2 disease. The incidence of lymphatic recurrence was lower in D3 patients with 50- to 100-mm tumors than in the corresponding D2 patients.

Conclusions: D3 gastrectomy might be beneficial in patients with advanced pN2 gastric cancer within the group with tumors measuring 50 to 100 mm. A randomized controlled trial of patients with 50- to 100-mm tumors should be performed to test the validity of this preliminary result.

Key Words: Advanced gastric cancer • D2 gastrectomy • D3 gastrectomy • Para-aortic lymph node dissection






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