The extent of lymph node dissection appropriate for gastric cancer is still under debate.
In this study, researchers from Japan and the Netherlands compared the results of a limited (D1) and extended (D2) lymph node dissection. They looked at morbidity, mortality, long-term survival and cumulative risk of relapse during a 10-year follow-up.
Overall, 1078 patients with gastric adenocarcinoma were randomly assigned to undergo a D1 or D2 lymph node dissection between 1989 and 1993.
|There was no overall difference in survival.|
|Journal of Clinical Oncology|
A total of 711 patients (380 in the D1 group and 331 in the D2 group) were treated with curative intent.
The team found that morbidity was 25% in the D1 group and 42% in the D2 group. Furthermore, mortality in the D1 group was 4%, compared with 10% in the D2 group.
However, after 11 years there was no overall difference in survival.
The researchers found that it was only patients with N2 disease who benefited from a D2 dissection.
Dr Hartgrink and colleagues concluded, “Overall, extended lymph node dissection as defined in this study generated no long-term survival benefit“.
“The associated higher postoperative mortality offsets its long-term effect in survival“.
“For patients with N2 disease an extended lymph node dissection may offer cure, but it remains difficult to identify patients who have N2 disease“.
“Morbidity and mortality are greatly influenced by the extent of lymph node dissection, pancreatectomy, splenectomy and age“.
“Extended lymph node dissections may be of benefit if morbidity and mortality can be avoided“.