A 10-year experience with Japanese-type radical lymph node dissection for gastric cancer outside of Japan

Abstract

Background. The prognosis for surgically treated gastric cancer remains poor in most Western countries compared with reports from Japanese investigators during the past 3 decades. Methods. A radical surgical procedure principally to extended lymphadenectomy as defined by the Japanese Research Society for Gastric Cancer was performed prospectively from January 1984 to June 30, 1994 for 512 patients with gastric cancer, 345 of whom were treated with potentially curative surgery. Clinical, histopathologic, and surgical factors were examined for their influence on long term survival by univariate and multivariate analyses. Results. Five‐ and 10‐year survival rates for all patients were 40.5% and 34.3%, respectively, and for patients who underwent tumor resection were 45.7% and 38.6%, respectively. For patients who underwent curative surgery, 5‐ and 10‐year adjusted survival rates were 57.7% and 44.3%, respectively, with a median survival of 96 months. Postoperative hospital mortality was 6.8%: 4.9% for R‐0 resected patients, 9% for R‐1 and R‐2 resected patients, and 13.4% for those with palliative procedures. Multivariate analysis using the Cox model identified age older than 65 years, prior total gastrectomy, an increasing number of positive lymph nodes, a high pathologic N classification, male sex, a high pT classification, and low preoperative hemoglobin level as detrimental factors with an independent influence on survival. Conclusion. Radical lymphadenectomy in this 10‐year Austrian study yielded survival rates similar to those in Japanese investigations without sacrificing low postoperative mortality. In particular, the relatively high overall survival rates seemed to reaffirm the value of radical lymph node dissection with wide resection margins.

Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers

“…However, the incidence of LN metastasis in intramucosal and submucosal EGCs has been reported as approximately 3% and 20%, respectively [17][18][19][20][21][22][23]; therefore, surgery may be excessive in many patients with these lesions. Considering the risks of gastrectomy and the negative effect on the patient's quality of life [24][25][26][27][28][29], if a group of patients with a negligible risk of LN metastasis can be defined, it is sensible to offer a local treatment for them. EMR for selected intramucosal EGC, for which the possibility of LN metastasis is almost zero, has been widely accepted as a therapeutic strategy for cure in Japan.…”

Gastric Cancer, Version 2.2013

“…Diller Family Comprehensive Cancer Center; 12 Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; 13 Moffitt Cancer Center; 14 University of Alabama at Birmingham Comprehensive Cancer Center; 15 UNMC Eppley Cancer Center at The Nebraska Medical Center; 16 Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; 17 Roswell Park Cancer Institute; 18 VanderbiltIngram Cancer Center; 19 Massachusetts General Hospital; and 20 National Comprehensive Cancer Network.…”

“…3 Two other reports from Western countries have also reported better outcomes for D2 lymph node dissection when performed according to the recommendations of Japanese Research Society of Gastric Cancer. 16,17 Investigators have long been arguing that if the complication rate after a D2 lymph node dissection could be decreased, then this procedure may have a benefit in selected patients. Although pancreatectomy and splenectomy have been widely performed with D2 lymph node dissection in Japan, both of these procedures have been shown to increase postoperative mortality and morbidity.…”

D3- versus D2-Dissektion beim Magenkarzinom Eine Fall-Kontroll-Studie hinsichtlich postoperativer Morbidität, Letalität und onkologischen Frühergebnissen

“…Auch auf mögliche Morbiditäts-und Überlebensunterschiede zwischen Gastrektomie und aboraler Magenresektion konnte durch dieses Design eingegangen werden. Diese werden nach derzeitigem Kenntnisstand -wenn auch nicht einheitlich [19] -als eher unwahrscheinlich angesehen [40].…”

“…Generell existieren bisher nur wenig Erfahrungsberichte über die Lymphdissektion unter Einschluss des Kompartiments D3 [1,9,16,17,19,22,25,30]. Insbesondere liegen keine klar definierten prospektiv randomisierte Studien vor, die Morbidität und Überleben nach D3-Dissektion mit weniger ausgedehnten Dissektionsformen vergleichen.…”