D2 Lymphadenectomy Alone or with Para-aortic Nodal Dissection for Gastric Cancer

Sasako, Mitsuru; Sano, Takeshi; Yamamoto, Seiichiro; Kurokawa, Yukinori; Nashimoto, Atsushi; Kurita, Akira; Hiratsuka, Masahiro; Tsujinaka, Toshimasa; Kinoshita, Taira; Arai, Kuniyoshi; Yamamura, Yoshitaka; Okajima, Kunio

doi:10.1056/nejmoa0707035

Cited by 909 publications

(636 citation statements)

References 32 publications

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“…The overall operative mortality rate of 1.6 % compares favorably with data from large contemporary audits, with the 2010 esophagogastric cancer audit of England and Welsh hospitals reporting an in-hospital mortality rate of 6 % for patients undergoing curative gastric resection [31]. The operative mortality rate of 2.5 % for our patients selected to have a D2 resection is comparable to the results published from internationally renowned centers [9,17,18,20] and is significantly less than the mortality rates reported from two of the published randomized trials of D1 versus D2 resection [11,32,33]. It is worth noting that we have performed far fewer resections involving the pancreas and the spleen, which was a major source of morbidity in the Dutch study [11].…”

Section: Discussionsupporting

confidence: 70%

“…Extended lymphadenectomy (D2/D3) for Electronic supplementary material The online version of this article (doi:10.1007/s10120-013-0240-3) contains supplementary material, which is available to authorized users. gastric cancer is routinely performed in Japanese surgical units [7,8], with large reported series demonstrating that it can be performed safely [9,10]. Two European randomized studies assessing the role of extended lymph node dissection (D2) failed to show any improvement in survival [11,12], but with associated higher mortality and morbidity rates in the extended lymphadenectomy group, as a result of splenic and pancreatic resection.…”

Section: Introductionmentioning

confidence: 99%

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Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

et al. 2013

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Background The incidence of gastric cancer is decreasing in Australia, yet it remains a common cause of cancerrelated mortality. Surgical resection remains the cornerstone of curative treatment. High-volume specialized units have reported superior perioperative and oncological outcomes. The role of D2 lymphadenectomy has been controversial as a result of concerns over increased morbidity. Our aim is to report the perioperative and oncological outcomes of curative gastric resection from a specialist Australian upper GI unit. Methods Data from a prospectively maintained database were reviewed for all patients undergoing curative resection for gastric adenocarcinoma from a single unit during a 12-year period. Perioperative and long-term outcomes were compiled. Results There were 255 curative gastric resections during 12 years. An R0 resection was performed in 96 % with a perioperative mortality rate of 1.6 %. A D2 dissection was performed in 85 % of cases in the past 6 years, with no increase in perioperative morbidity or mortality detected. The 5-year overall survival was 53 %. Conclusion Our results demonstrate that both short-and long-term outcomes of surgical resection in gastric cancer patients, comparable to international high-volume centers, can be achieved in an Australian upper GI unit. A D2 lymph node dissection can be performed safely without any increase in perioperative risk in a specialist unit that has the necessary training but also the perioperative support structures to manage these complex patients.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

et al. 2013

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“…In a separate trial, Sasako et al . was able to demonstrate the feasibility of carrying out para‐aortic dissection on top of D2 lymphadenectomy for gastric cancer, although there was no benefit to the 5‐year overall survival 24, 25. Most recently, Sano et al 26.…”

Section: Gastric Surgerymentioning

confidence: 99%

Gastroenterological surgery in Japan: The past, the present and the future

Colvin

Mizushima

Eguchi

et al. 2017

Annals of Gastroent Surgery

138

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In the last two centuries, there has been remarkable progress in the field of gastroenterological surgery, including the curative resection of cancers, replacement of failed organs through transplantation, increased safety of undergoing major surgeries and decreased operative morbidity through developments in minimal access surgery. Japan has very much been at the forefront of these advances, as is evident from the present review, from advancing the surgical management of gastric cancer to the pioneering work in live‐donor transplantation. This review also highlights many instances where surgical management of the same pathologies has evolved differently between Japan and the West. It is encouraging that many procedures established in Japan are eventually taken up by the West, often after rigorous assessment affirming the quality and applicability of such techniques. In Japan, many of the crucial issues in gastroenterological surgery are increasingly addressed through large multi‐institutional prospective control trials, ensuring that Japanese surgeons continue to contribute to the advances in gastroenterological surgery.

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“…A recent reported clinical trial, at 24 japanese hospitals, comparing D2 lymphadenectomy alone with D2 procedure with para-aortic nodal dissection for gastric cancer, has shown that no improvement in the survival rate has been obtained 30 .…”

Section: Discussionmentioning

confidence: 99%

Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials

et al. 2008

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Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer. Meta-analysis of randomized clinical trials 1 Impacto da linfadenectomia ampliada na morbidade, mortalidade, recidiva e cinco anos de sobrevida após gastrectomia por câncer. Effect of a combination of medium chain triglycerides, linoleic acid, soy lecithin and vitamins A and E on wound healing in rats

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D2 Lymphadenectomy Alone or with Para-aortic Nodal Dissection for Gastric Cancer

Abstract: As compared with D2 lymphadenectomy alone, treatment with D2 lymphadenectomy plus PAND does not improve the survival rate in curable gastric cancer. (ClinicalTrials.gov number, NCT00149279.)

Cited by 909 publications

References 32 publications

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

Gastroenterological surgery in Japan: The past, the present and the future

Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials

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