BACKGROUND:Japanese surgeons have been actively performing extended lymphadenectomy (D2, removal of perigastric nodes and nodes along the left gastric, common hepatic, celiac and splenic arteries; or D3, D2 plus removal of nodes in the hepatoduodenal ligament, in the retropancreatic space and along the vessels of the transverse mesocolon). In recent years interest has expanded to superextended lymphadenectomy (D4) of nodes around abdominal aorta (para-aortic lymph nodes from aortic hiatus to aortic bifurcation). Because the therapeutic value of this D4 procedure remains controversial, we initiated a prospective study to compare D3 and D4 lymphadenectomy. METHODS:Seventy patients with T3 or T4 gastric cancer and without macroscopic metastasis to the para-aortic nodes treated by potentially curative total gastrectomy were randomized to D4 (group A, n = 35) and D3 (group B, n = 35) lymphadenectomies. RESULTS: Metastases to para-aortic nodes were found in 4 patients. Postoperative survival after D4 resection was not statistically significant between the groups. Postoperative morbidity for group A was greater. In group A 4 patients had postoperative retention of intra-abdominal fluid (lymphorrhea) and 4 others had prolonged diarrhea. One patient in each group died of postoperative complications. CONCLUSIONS: Surgical treatment of microscopic disease in grossly normal para-aortic lymph nodes may generate occasional long-term survivors. Selecting appropriate candidates who might benefit from D4 resections needs to be refined. On the basis of this study, a nationwide study should be considered.
RCT Entities:
BACKGROUND: Japanese surgeons have been actively performing extended lymphadenectomy (D2, removal of perigastric nodes and nodes along the left gastric, common hepatic, celiac and splenic arteries; or D3, D2 plus removal of nodes in the hepatoduodenal ligament, in the retropancreatic space and along the vessels of the transverse mesocolon). In recent years interest has expanded to superextended lymphadenectomy (D4) of nodes around abdominal aorta (para-aortic lymph nodes from aortic hiatus to aortic bifurcation). Because the therapeutic value of this D4 procedure remains controversial, we initiated a prospective study to compare D3 and D4 lymphadenectomy. METHODS: Seventy patients with T3 or T4 gastric cancer and without macroscopic metastasis to the para-aortic nodes treated by potentially curative total gastrectomy were randomized to D4 (group A, n = 35) and D3 (group B, n = 35) lymphadenectomies. RESULTS:Metastases to para-aortic nodes were found in 4 patients. Postoperative survival after D4 resection was not statistically significant between the groups. Postoperative morbidity for group A was greater. In group A 4 patients had postoperative retention of intra-abdominal fluid (lymphorrhea) and 4 others had prolonged diarrhea. One patient in each group died of postoperative complications. CONCLUSIONS: Surgical treatment of microscopic disease in grossly normal para-aortic lymph nodes may generate occasional long-term survivors. Selecting appropriate candidates who might benefit from D4 resections needs to be refined. On the basis of this study, a nationwide study should be considered.
Authors: Roman Yarema; Giovanni de Manzoni; Taras Fetsych; Myron Ohorchak; Mykhailo Pliatsko; Maria Bencivenga Journal: World J Gastrointest Oncol Date: 2016-06-15
Authors: Giovanni De Manzoni; Gian Luca Baiocchi; Massimo Framarini; Maurizio De Giuli; Domenico D'Ugo; Alberto Marchet; Donato Nitti; Daniele Marrelli; Paolo Morgagni; Andrea Rinnovati; Riccardo Rosati; Franco Roviello; Rosaldo Allieta; Stefano Berti; Umberto Bracale; Patrizio Capelli; Angelo Cavicchi; Natale Di Martino; Annibale Donini; Angelo Filippini; Gianfranco Francioni; Marco Frascio; Alfredo Garofalo; Stefano Maria Giulini; Giovanni Battista Grassi; Paolo Innocenti; Antonio Martino; Gualtiero Mazzocconi; Lorenzo Mazzola; Severino Montemurro; Nicola Palasciano; Gianni Pantuso; Heinrich Pernthaler; Roberto Petri; Diego Piazza; Rosario Sacco; Giovanni Sgroi; Carlo Staudacher; Michele Testa; Carlo Vallicelli; Nereo Vettoretto; Costantino Zingaretti; Lorenzo Capussotti; Mario Morino; Giorgio Maria Verdecchia Journal: Updates Surg Date: 2014-03