S Rausei1, L Ruspi2, F Rosa3, P Morgagni4, D Marrelli5, A Cossu6, F C M Cananzi7, R Lomonaco8, A Coniglio9, A Biondi10, C Cipollari11, L Graziosi12, U Fumagalli13, F Casella14, P Bertoli15, A di Leo16, S Alfieri3, G Vittimberga4, F Roviello5, E Orsenigo6, V Quagliuolo7, S Montemurro8, G Baiocchi9, R Persiani10, M Bencivenga11, A Donini12, R Rosati17, A Sansonetti14, L Ansaloni15, A Zanoni16, F Galli2, G Dionigi2. 1. Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy. Electronic address: stefano.rausei@ospedale.varese.it. 2. Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy. 3. Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy. 4. General Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, FC, Italy. 5. Department of General Surgery and Oncology, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci, 53100 Siena, SI, Italy. 6. Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy. 7. Division of Surgical Oncology, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy. 8. Surgery Unit, National Cancer Research Centre, Giovanni Paolo II, Viale Orazio Flacco 65, 70124 Bari, BA, Italy. 9. Department of Clinical and Experimental Sciences, Brescia University, Piazzale Spedali Civili, 1, 25123 Brescia, BS, Italy. 10. Division of General Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy. 11. Department of Surgery, University of Verona, Ospedale Borgo Trento, P.le A. Stefani 1, 37126 Verona, VR, Italy. 12. General and Emergency Surgery, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, PG, Italy. 13. Division of General and Minimally Invasive Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy. 14. Division of General Surgery, Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, RM, Italy. 15. Division of General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, BG, Italy. 16. Division of General Surgery, Rovereto Hospital, Corso Verona, 4, 38068 Rovereto, TN, Italy. 17. Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy; Division of General and Minimally Invasive Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy.
Abstract
BACKGROUND: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. METHODS: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. RESULTS: Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. CONCLUSION: Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.
BACKGROUND: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. METHODS: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancerpatients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. RESULTS: Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. CONCLUSION: Extended lymphadenectomy confirmed better survival rates in gastric cancerpatients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancerpatients.
Authors: V Rodrigues; F Landi; S Castro; R Mast; N Rodríguez; A Gantxegi; J Pradell; M López-Cano; M Armengol Journal: J Gastrointest Surg Date: 2020-07-13 Impact factor: 3.452
Authors: Zheng-Yan Li; Jie Chen; Bin Bai; Shuai Xu; Dan Song; Bo Lian; Ji-Peng Li; Gang Ji; Qing-Chuan Zhao Journal: Gastroenterol Rep (Oxf) Date: 2020-09-10