Writing in the July issue of the journal, the Japan Clinical Oncology Group has conducted a randomized controlled trial to examine morbidity and mortality results when comparing D2 and extended para-aortic lymphadenectomy.
Radical gastrectomy with regional lymphadenectomy is the only curative treatment option for gastric cancer, but the extent of lymphadenectomy remains controversial.
The 2 European randomized trials that have been conducted on this topic both reported an increase in operative morbidity and mortality, and failed to show any survival benefit in the Ds lymphadenectomy group.
The Japanese group has therefore compared the Japanese standard D2 and D2 + para-aortic nodal dissection.
|Para-aortic lymphadenectomy could be added without increasing major surgical complications|
|Journal of Clinical Oncology|
Only surgeons experienced in both procedures were allowed to participate in the study, in which patients with potentially curable gastric adenocarcinoma (T2 subserosa, T3, or T4) who were surgically fit were intra-operatively randomized.
Postoperative morbidity and hospital mortality were recorded prospectively in a fixed format and were compared between the 2 groups in this study.
A total of 523 patients were randomized between July 1995 and April 2001, with postoperative complications reported in 24.5% of all patients.
Although the morbidity for the extended surgery group (28.1%) was slightly higher than the standard group (20.9%), there was no difference in the incidence of 4 major complications (anastomotic leak, pancreatic fistula, abdominal abscess, pneumonia) between the 2 groups.
Hospital mortality was reported at 0.80%: 1 patient in each group died of operative complications, while 1 from each group died of rapid progressive cancer while an in-patient.
From these results the authors conclude that specialized surgeons could safely perform gastrectomy with D2 lymphadenectomy in patients with low operative risks.
They add that para-aortic lymphadenectomy could be added without increasing major surgical complications in this setting.