BACKGROUND: The operative mortality in gastric cancer surgery has been reported to be higher with D2 lymphadenectomy than with D1 in the West. The modified radical lymphadenectomy (D1.5) may be safer than D2 under these circumstances. This study was aimed to determine whether D1.5 would deteriorate long-term survival as compared with D2. METHOD: Since the concept of the extent of lymphadenectomy varied among the surgeons, 461 patients who underwent curative gastrectomy for T2-4 gastric adenocarcinoma were retrospectively categorized into three groups according to the surgeon: D1 with dissection along the left gastric and common hepatic arteries (D1.5); lymphadenectomy between D1.5 and D2; D2 or more extended dissection. RESULTS: No differences were found in the survival rates among the three groups within each of the T2a, T2b, and T3 categories. According to a multivariate analysis using Cox's proportional hazard model, the classification according to the surgeons had no survival impact (p>0.8). CONCLUSION: D1.5 lymphadenectomy resulted in a survival rate that was almost equal to that of D2. The use of D1.5 instead of D2 can be an attractive option to be compared with D1 in future trials.
BACKGROUND: The operative mortality in gastric cancer surgery has been reported to be higher with D2 lymphadenectomy than with D1 in the West. The modified radical lymphadenectomy (D1.5) may be safer than D2 under these circumstances. This study was aimed to determine whether D1.5 would deteriorate long-term survival as compared with D2. METHOD: Since the concept of the extent of lymphadenectomy varied among the surgeons, 461 patients who underwent curative gastrectomy for T2-4 gastric adenocarcinoma were retrospectively categorized into three groups according to the surgeon: D1 with dissection along the left gastric and common hepatic arteries (D1.5); lymphadenectomy between D1.5 and D2; D2 or more extended dissection. RESULTS: No differences were found in the survival rates among the three groups within each of the T2a, T2b, and T3 categories. According to a multivariate analysis using Cox's proportional hazard model, the classification according to the surgeons had no survival impact (p>0.8). CONCLUSION: D1.5 lymphadenectomy resulted in a survival rate that was almost equal to that of D2. The use of D1.5 instead of D2 can be an attractive option to be compared with D1 in future trials.
Authors: J J Bonenkamp; J Hermans; M Sasako; C J van de Velde; K Welvaart; I Songun; S Meyer; J T Plukker; P Van Elk; H Obertop; D J Gouma; J J van Lanschot; C W Taat; P W de Graaf; M F von Meyenfeldt; H Tilanus Journal: N Engl J Med Date: 1999-03-25 Impact factor: 91.245
Authors: A Cuschieri; S Weeden; J Fielding; J Bancewicz; J Craven; V Joypaul; M Sydes; P Fayers Journal: Br J Cancer Date: 1999-03 Impact factor: 7.640
Authors: Mario Sianesi; Lamia Bezer; Paolo Del Rio; Paolo Dell'Abate; Gioacchino Iapichino; Paolo Soliani; Sara Tacci Journal: J Gastrointest Surg Date: 2010-01-26 Impact factor: 3.452