Long-term results of tailored D2 lymph node dissection after R0 surgery for gastric cancer

Abstract

Implementation of extended lymph node dissection for gastric cancer in western non-specialized centers through tailoring its extent upon disease stage and patient comorbidities was suggested as a wise policy to reduce morbidity and mortality rates, albeit with a potential for undertreatment in elderly and/or comorbid patients. Current definition of R(0) resection for gastric cancer lacks consideration of treatment-related variables such as extended lymph node dissection. Few studies to date have tried to fill this gap in such a clinical context. A retrospective evaluation of factors influencing long-term results after R(0) surgery was done in a prospective series of a non-specialized western surgical unit during the implementation of D(2) lymphadenectomy. Univariate and multivariate analysis of 22 variables were performed on a prospective database of 233 consecutive R(0) resections performed by ten different surgeons in 10 years. Endpoint was disease-free survival calculated at 5 and at 10 years. Disease-free survival rates were independently influenced by age, American Society of Anesthesiologists (ASA) status and lymph node ratio. Subset analysis of the status at censor stratified for age and ASA status failed to identify any significant difference in disease recurrence rates. Lymph node ratio was the only treatment-related independent prognostic factor for long-term results after R(0) surgery for gastric cancer in the setting of a non-specialized western unit, where the extent of lymph node dissection needs to be tailored on the presence of comorbidities (ASA status).

The pattern of lymph node metastasis and the suitability of 7th UICC N stage in predicting prognosis of remnant gastric cancer

“…It was acknowledged that MLNs was a well-established prognostic factor for gastric carcinoma (Catarci et al 2011;Reis et al 2002). In many study, it had been demonstrated that the 7th UICC N stage was superior to the 5th/6th UICC N stage and Japanese N stage for prognostic prediction of gastric cancer by using Cox regression multivariate analysis (Deng et al 2010).…”

“…As LN metastasis occurs during the early stages of this disease, regional lymphadenectomy is recommended as part of radical gastrectomy (Catarci et al 2011;Reis et al 2002).…”

Pancreatic enzyme supplementation after gastrectomy for gastric cancer: a randomized controlled trial

“…Indication for DSG or TG and extent of lymph node dissection have been previously described [23, 24]. Reconstruction of digestive tract continuity after DSG consisted of a Roux-en-Y single-layer hand-sewn gastrojejunostomy and a Roux-en-Y stapled (25-mm circular stapler) esophagojejunostomy after TG.…”

Prognostic Value of Tumor Size in Patients with Remnant Gastric Cancer: Is the Seventh UICC Stage Sufficient for Predicting Prognosis?

“…Lymph node (LN) metastasis is the most common metastatic pattern of RGC, and regional lymphadenectomy is recommended as part of radical gastrectomy [8] , [9] . It was recently acknowledged that the total number of metastatic LNs is a more reliable prognostic indicator than positive anatomical lymphatic stations [10] .…”