A critical evaluation of effectivity of extended lymphadenectomy in patients with carcinoma of the stomach. An analysis of early results and long-term survival.

The therapeutic benefit of extended lymphadenectomy in patients with gastric cancer is not generally accepted. We therefore analyzed the data of 82 patients with total gastrectomy and extended lymphadenectomy (compartment I: lymph nodes 1-6 and compartment II: lymph nodes 7-11) from 1979 to 1986 (GL group) for morbidity, mortality and survival and compared these with the results of a historical control group of 81 patients from 1971 to 1986 (group G), who similarly had undergone total gastrectomy but only compartment-I lymphadenectomy (lymph nodes 1-6). The 30-day operative mortality in the GL group was 6% (5/82), which was no higher than that of the control group (9.5%, 4/42) during the same observation period (1979-1986). The comparison of the actuarial survival according to the old TNM system (UICC 1978) in both groups showed no significant differences: stages I and II P = 0.22, stage III P = 0.29, all curative cases (stages I+II+III) P = 0.12. In addition, the patients of the GL group were restaged according to the new TNM system (UICC 1987). The calculated 5-year survival rate in this group was: stage I, 89%; stage II, 64%; stage III, 21%; curative total (stages I+II+III), 62%; stage IV, 0%. All patients (n = 12) with involvement and dissection of lymph nodes of compartment II died within 38 months. Only two of these patients (17%) had a potentially curative operation. Our results indicate that compartment-II lymph node dissection did not influence the operative mortality or the prognosis compared with compartment-I lymphadenectomy. Since patients with positive lymph nodes in compartment II did not benefit from the extended lymph node dissection of this area, obviously because of systemic spread, the question of the effectiveness of the extended lymphadenectomy remains unresolved.