The survival benefit and morbidity after nodal dissection for gastric cancer remains controversial.
Professor Prof Chew-Wun Wu and colleagues undertook a single-institution randomized trial in patients with gastric cancer.
The research team compared D1 lymphadenectomy with D3 dissection for gastric cancer in terms of overall survival and disease-free survival.
From 1993 to 1999, the researchers registered 335 patients.
Of these, 221 patients were eligible, and 110 were randomly assigned D1 surgery and 111 were randomized to D3 surgery, both with curative intent.
The team reported that 3 participating surgeons had done at least 25 independent D3 dissections before the start of the trial.
Every procedure was verified by pathological analyses.
The primary endpoints were 5-year overall survival and 5-year disease-free survival.
|Overall 5-year survival was 60% with D3 surgery vs 54% with D1 surgery|
The researchers also analyzed risk of recurrence, and used intention to treat for the main analyses.
Median follow-up for the 110 survivors was 95 months.
The team found that the overall 5-year survival was 60% in patients assigned D3 surgery, and 54% in those assigned D1 surgery.
The team noted that 215 patients who had resection with no microscopic evidence of residual disease, had recurrence at 5 years of 51% for D1 surgery.
The recurrence rate at 5-years in these patients with D3 surgery was 40%.
Professor Wu's team concludes, “D3 nodal dissection, compared with that of D1, offers a survival benefit for patients with gastric cancer when done by well trained, experienced surgeons.”