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Annals of Surgical Oncology 9:401-405 (2002)
© 2002 Society of Surgical Oncology

ORIGINAL ARTICLES

Is D2 Lymph Node Dissection Necessary for Early Gastric Cancer?

Takaki Yoshikawa, MD, PhD, Akira Tsuburaya, MD, DMedSc, Osamu Kobayashi, MD, DMedSc, Motonori Sairenji, MD, DMedSc, Hisahiko Motohashi, MD, DMedSc and Yoshikazu Noguchi, MD, DMedSc

From the Department of Gastrointestinal Surgery (TY, AT, OK, MS, HM), Kanagawa Cancer Center Hospital, Yokohama, Japan; and Department of Surgery (YN), Yokohama Kowan Hospital, Yokohama, Japan.

Correspondence: Address correspondence and reprint requests to: Takaki Yoshikawa, MD, PhD, Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama 241, Japan; Fax: 81-45-361-4692; E-mail: yoshika{at}yc5.so-net.ne.jp

Background: The objective of this study was to clarify a survival benefit of D2 lymphadenectomy in patients with early gastric carcinoma (GC).

Methods: A retrospective study was conducted to examine the incidence of metastasis to level 2 lymph nodes, the causes of postoperative death, and the mode of recurrence in 1041 patients who had early GC and underwent D2 lymphadenectomy with curative intent.

Results: Postoperative mortality occurred in 129 (12.4%) of 1041 patients, 6 patients (.6%) died of surgical complications, 108 (10.2%) died of diseases other than cancer, and 16 (1.5%) died of recurrence. Hematogenous metastasis was the major mode of recurrence (56.3% of recurrences). The incidence of metastasis to level 2 nodes was 2.5% (26 of 1041 patients, 18 of whom were alive). Thus, the estimated survival benefit of radical lymphadenectomy for patients with early GC was calculated to be 1.7% (18 of 1041 patients).

Conclusions: D2 lymphadenectomy in patients with early GC had little survival benefit because (1) metastasis to level 2 nodes was rare, (2) most causes of death were not related to the tumor, and (3) more than half the recurrences were hematogenous. Use of radical lymphadenectomy for early GC should be limited.

Key Words: Gastric carcinoma • Lymph node dissection • Prognosis • Survival






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