Extended lymph node dissection without routine spleno-pancreatectomy for treatment of gastric cancer: Low morbidity and mortality rates in a single center series of 250 patients

Biffi, R.; Chiappa, Antonio; Luca, Fabrizio; Pozzi, S.; Faso, Felice Lo; Cenciarelli, Sabine; Andreoni, Bruno

doi:10.1002/jso.20495

Cited by 46 publications

(34 citation statements)

References 23 publications

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“…Furthermore, recent studies conducted in the West also show the importance of hospital volume and surgeon volume, indicating that both factors are directly related to the best results in the short term [16,17]. For example, it has been reported that mortality decreased signifi cantly in hospitals performing more than 63 gastrectomies per year [18].…”

Section: Discussionmentioning

confidence: 99%

Results of specialization in the surgical treatment of gastric cancer in Peru

et al. 2007

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Section: Discussionmentioning

confidence: 99%

Results of specialization in the surgical treatment of gastric cancer in Peru

et al. 2007

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“…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. This result has led to a shift from routine resection of the distal pancreas and spleen to a much more selective approach [13][14][15][16]. A more recent randomized study from a Western surgical center was able to demonstrate no increase in morbidity or mortality rates with D2 lymphadenectomy [17]; this has also been reported in numerous nonrandomized studies from specialized units with an interest in gastric cancer, demonstrating that a D2 lymph node dissection can be performed safely with good outcomes [10,15,[18][19][20][21].…”

Section: Introductionmentioning

confidence: 98%

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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“…Two large, prospective randomized trials performed in The Netherlands and the United Kingdom found no survival benefit for D2 over D1 lymphadenectomy [6,7]. However, there were significant problems with these studies, including a high morbidity and mortality rate in the D2 group, which was associated with inadequate surgical training, and with the frequent performance of a distal pancreatectomy and splenectomy in the D2 group, which is now considered unnecessary [8,9].…”

Section: Introductionmentioning

confidence: 99%

Lymphadenectomy for Gastric Adenocarcinoma: Should West Meet East?

Yoon

Yang

2009

The Oncologist

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After completing this course, the reader will be able to:1. Calculate the lymph node drainage patterns of gastric adenocarcinoma based on the location of the tumor.2. Differentiate and explain the extent of lymphadenectomies performed in different countries.3. Analyze the risks and benefits of performing more extensive lymphadenectomies for gastric adenocarcinoma.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe extent of lymphadenectomy that should be performed for gastric adenocarcinoma has been a topic of persistent debate. In countries such as Japan and Korea, where the incidence of gastric adenocarcinoma is high, more extensive (e.g., D2) lymphadenectomies are routinely performed, usually by experienced surgeons with low morbidity and mortality. In western countries such as the U.S., where the incidence of gastric adenocarcinoma is tenfold lower, the performance of more extensive lymphadenectomies is generally limited to specialized centers, and quite possibly the majority of patients are treated at nonreferral centers with less than a D1 lymphadenectomy. There is little disagreement among gastric cancer experts that the minimum lymphadenectomy that should be performed for gastric adenocarcinoma should be at least a D1 lymphadenectomy. Two large, prospective randomized trials performed in the United Kingdom and the Netherlands failed to demonstrate a survival benefit of D2 over D1 lymphadenectomy, but these trials have been criticized for high surgical morbidity and mortality rates in the D2 group. More recent studies have demonstrated that western surgeons can be trained to perform D2 lymphadenectomies on western patients with low morbidity and mortality. Retrospective analyses and one prospective, randomized trial suggest that there may be some benefits to more extensive lymphadenectomies when performed safely, but this assertion requires further validation. This article provides an update on the current literature regarding the extent of lymphadenectomy for gastric adenocarcinoma.

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Extended lymph node dissection without routine spleno-pancreatectomy for treatment of gastric cancer: Low morbidity and mortality rates in a single center series of 250 patients

Abstract: These results compete favorably with those reported after standard D-1 gastrectomy in Western patients series. D-2 gastrectomy with spleen and pancreas routine preservation can be considered a safe treatment for gastric cancer in Western patients, at least in experienced centers.

Cited by 46 publications

References 23 publications

Results of specialization in the surgical treatment of gastric cancer in Peru

Results of specialization in the surgical treatment of gastric cancer in Peru

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

Lymphadenectomy for Gastric Adenocarcinoma: Should West Meet East?

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