Evidence of survival benefit of extended (D2) lymphadenectomy in Western patients with gastric cancer based on a new concept: A prospective long-term follow-up study

Roukos, Dimitrios H; Lorenz, M; Encke, A.

doi:10.1067/msy.1998.88094

Cited by 134 publications

(82 citation statements)

References 24 publications

(24 reference statements)

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“…An essential condition is that good early postoperative results in terms of morbidity and mortality should be ensured. This is consistent with the reports of observational non-randomized studies from specialized centers (6)(7)(8)(9)18,(26)(27)(28).…”

Section: Lymphadenectomy For Advanced Formssupporting

confidence: 82%

“…However, the benefit of extended (D2) lymphadenectomy remained a matter of debate for long time, above all in Western countries, in light of the results of the Dutch and British randomized studies, which showed no evidence of overall survival benefit after D2 dissection compared with the D1, at the expenses of much higher postoperative mortality rates (4,5). These results were much discordant as compared with observational data from specialized Western centers, which reported low complications rates and postoperative mortality risk, with high longterm survival rates even in advanced nodal stages (6)(7)(8)(9). Some clarifications were provided by the re-evaluation of long-term results of the Dutch trial, which showed a reduction of locoregional recurrence and GC-related deaths, above all in the long-term, in patients treated by D2 lymphadenectomy (10,11).…”

Section: Introductioncontrasting

confidence: 54%

“…The correct procedure of extended lymphadenectomy requires specialized experience in gastro esophageal surgery with an appropriate learning curve; indeed, the complication and mortality rates reported in the specialized Western centers are limited, generally overlapping or slightly higher than those reported by the Japanese authors (6)(7)(8)(9)18,(26)(27)(28)42,43). Furthermore, it is particularly important to limit the use of splenopancreatic resection to only selected cases.…”

Section: Early Resultsmentioning

confidence: 83%

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Lymphadenectomy: state of the art

Marrelli

Franco

Iudici

et al. 2017

Transl. Gastroenterol. Hepatol.

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The extent of lymphadenectomy in gastric cancer (GC) surgery has been for long time a matter of debate. Randomized trials performed in the West reported worse results of D2 dissection, in terms of postoperative complications and long-term survival benefit, than Eastern series and observational studies from specialized Western centers. However, long-term re-evaluation of such trials and in depth-analysis of other experiences demonstrated the potential benefit of D2 in reducing the probability of cancer-related death and the safety of this procedure when avoiding unnecessary spleno-pancreatectomy and in centers with ad adequate surgical volume. Nowadays, the D2 is considered the standard treatment in most guidelines all over the world. More limited procedures (D1, D1 plus) may be adequate in selected cases, and more extended dissections (D2 plus) could be indicated in advanced forms with high risk of metastases to distant nodes, but in specialized centers or in the setting of clinical studies. The integration with neoadjuvant therapies and multimodality approach could offer a chance of cure in groups of patients with poor results when approached with standard treatment.

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Section: Lymphadenectomy For Advanced Formssupporting

confidence: 82%

Section: Introductioncontrasting

confidence: 54%

Section: Early Resultsmentioning

confidence: 83%

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Lymphadenectomy: state of the art

Marrelli

Franco

Iudici

et al. 2017

Transl. Gastroenterol. Hepatol.

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“…Extended (D2) lymph node dissection was performed using a systematic and standardized technique according to the guidelines of the JRSGC. D2 node dissection in our study entailed the removal of perigastric compartment I nodes (stations 1 to 6, attached to the stomach: D1 dissection) and the extraperigastric compartment II nodes (stations 7 to 12) using a technique previously described (Roukos et al, 1998). The total gastrectomy specimen with greater and lesser omenta and containing nodal stations 1 through 6, including the nodes along the left gastric artery (station 7) was removed enblock and sent to the pathologist.…”

Section: Surgerymentioning

confidence: 99%

Pathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: A prospective with quality control 10-year follow-up study

et al. 2001

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UICC classification accurately predicts overall survival but not recurrence-risk. We report here data of overall and first site-specific recurrence following curative surgery useful for the development of recurrence-oriented preventive target therapies. Patients who underwent resection for gastric cancer were stratified according to curability of surgery [curative (R0) vs non-curative resection], extent of surgery [limited (D1) vs extended (D2) node dissection] and pathological nodal/serosal status. The intent-to-treat principle, log-rank test and Cox regression analysis were used for statistical analysis of time-to-event (recurrence, death) endpoints. Curative resection only produced a chance of cure whereas survival was very poor following non-curative resection ( P < 0.0001). For D2 R0 subgroup of patients, a pathological serosa and a node state-based classification into three groups, proved to be of clinical implication. Risk of recurrence after a median follow-up of 92 months was low among patients with both serosa and node-negative cancer (first group; 11%), moderate among those with either serosa or node-positive cancer (second group; 53%) and very high among those with both serosa and node-positive cancer (third group; 83%). In multivariate analysis, the relative risks of recurrence and death from gastric cancer among patients in the second and third groups, as compared to those in the first, were 7.07 (95% CI, 2.36–21.17; P = 0.0002) and 16.19 (95% CI, 5.76–45.54; P < 0.0001) respectively. First site-specific recurrence analysis revealed: low rate of loco-regional recurrence alone (12%), serosa state determinant factor of the site-recurrence (peritoneal for serosa-positive and haematogenous for serosa-negative cancers) and dramatic increase of all types of recurrence by the presence of nodal metastases. Our findings demonstrate that a pathological serosa- and node-based classification is very simple and predicts accurately site-specific recurrence-risks. Furthermore they reveal that risk of recurrence following curative D2 surgery alone is low for serosa- and node-negative cancers, but very high in serosa- and node-positive cancers suggesting the need for new therapeutic strategies in this subgroup of patients. © 2001 Cancer Research Campaign http://www.bjcancer.com

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“…In the West, the higher prevalence of proximal gastric cancers, and patient factors such as older age, higher body mass index and higher incidence of comorbidities make the surgical management more challenging,15, 16, 17 has perhaps resulted in the tradition of carrying out a more limited lymph node dissection. Despite this, there is now a wider uptake of extended lymphadenectomy in countries other than Japan, and this is thought to be behind the significant improvement in long‐term survival 18, 19, 20, 21, 22…”

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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Evidence of survival benefit of extended (D2) lymphadenectomy in Western patients with gastric cancer based on a new concept: A prospective long-term follow-up study

Cited by 134 publications

References 24 publications

Lymphadenectomy: state of the art

Lymphadenectomy: state of the art

Pathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: A prospective with quality control 10-year follow-up study

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

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