Prognostic relevance of systematic lymph node dissection in gastric carcinoma

Siewert,; Böttcher, K.; Jd, Roder; Busch, Raymonde; Hermanek, P.; Hj, Meyer

doi:10.1002/bjs.1800800829

Cited by 446 publications

(261 citation statements)

References 13 publications

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“…Our results are similar to those previously reported by Pacelli et al (1993) in their retrospective trial and by Siewert et al (1993) in their prospective nonrandomised trial.…”

Section: Survival Of Igcsg D2 Gastrectomy Phase II Study M Degiuli Et Alsupporting

confidence: 93%

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Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

Degiuli¹,

et al. 2004

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Curative resection is the treatment of choice for potentially curable gastric cancer. Two major Western studies in the 1990s failed to show a benefit from D2 dissection. They showed extremely high postoperative mortality after D2 dissection, and were criticised for the potential inadequacy of the pretrial training in the new technique of D2 dissection, prior to the phase III studies being initiated. The inclusion of pancreatectomy and splenectomy in D2 dissection was associated with increased morbidity and mortality. Following these results, we started a phase II trial to evaluate the safety and efficacy of pancreas-preserving D2 dissection. The results of this trial regarding the safety of pancreas preserving D2 dissection were published in 1998. In this paper, we present the survival results of this phase II trial to confirm the rationale of carrying out a phase III study comparing D1 vs D2 dissection for curable gastric cancer. Italian patients with histologically proven gastric adenocarcinoma were registered in the Italian Gastric Cancer Study Group Multicenter trial. The study was carried out based on the General Rules of the Japanese Research Society for Gastric Cancer. A strict quality control system was achieved by a supervising surgeon of the reference centre who had stayed at the National Cancer Center Hospital, Tokyo, to learn the standard D2 gastrectomy and the postoperative management. The standard procedure entailed removal of the first and second tier lymph nodes. During total gastrectomy, the pancreas was preserved according to the Maruyama technique. Complete follow-up was available to death or 5 years in 100% of patients and the median follow-up time was 4.38 years. Out of 297 consecutive patients registered, 191 patients were enrolled in the study between May 1994 and December 1996. The overall morbidity rate was 20.9%. The postoperative in-hospital mortality was 3.1%. The overall 5-year survival rate among all eligible patients was 55%. Survival was strictly related to stage, depth of wall invasion, lymph node involvement and type of gastrectomy (distal vs total). Our results suggest a survival benefit for pancreas-preserving D2 dissection in Italian patients with gastric cancer if performed in experienced centres. A phase III trial among exclusively experienced centres is urgently needed.

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“…Our results are similar to those previously reported by Pacelli et al (1993) in their retrospective trial and by Siewert et al (1993) in their prospective nonrandomised trial.…”

Section: Survival Of Igcsg D2 Gastrectomy Phase II Study M Degiuli Et Alsupporting

confidence: 93%

“…Favourable patient survival after D2 gastrectomy has also been reported by some other non-Japanese retrospective nonrandomised trials (Pacelli et al, 1993;Siewert et al, 1993).…”

supporting

confidence: 67%

Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

Degiuli¹,

et al. 2004

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“…These findings were confirmed by another German study (Siewert et al, 1993). They prospectively registered and analysed gastrectomies with extended lymphadenectomies in 19 hospitals, of which 16 were university hospitals and concluded that radical lymphadenectomy (> 26 nodes) improved survival rate compared to < 26 nodes.…”

Section: Discussionmentioning

confidence: 67%

Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value

et al. 2001

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SummaryThe main change in the 5th edition (1997) of the TNM classification for gastric cancer compared to the 4th edition (1987) is the use of the number of involved nodes instead of the location of positive nodes. As a result stage grouping is also altered. A second change is the requirement for the examination of at least 15 nodes to justify the N0 status. Patients with fewer examined negative nodes are unclassifiable (Nx). Data were retrieved from a randomized trial database comparing D1 and D2 dissection and 633 curatively operated patients were included. According to the criteria of the 5th edition, 39% of the node-positive patients had another N stage compared to the 4th: 21% had a lower and 18% had a higher stage. 5-year survival rates according to the 4th edition N0, N1 and N2 groups were respectively 72%, 34% and 27%. According to the 5th edition these percentages were for the N0, N1, N2, N3 and Nx groups respectively 75%, 38%, 19%, 8% and 65%. The former 1987 N1 and N2 group were significantly split into three new N 1997 groups (P = 0.006, respectively P < 0.0005). The Cox's regression analysis showed the N 1997 classification to be the most important prognostic variable, with a higher prognostic value than N 1987. In addition, the new TNM stage was also a better prognosticator. The requirement for examining at least 15 nodes, however, could not be fulfilled in 38% of all nodenegative patients and we found that a minimum of 5 consecutive negative lymph nodes is a reliable number for staging purposes. We conclude that the 5th edition of the TNM classification provides a better estimation of prognosis, however, examination of at least 15 negative regional lymph nodes is too high a threshold and 5 gives similar prognostic value. 64-71 © 2001 Cancer Research Campaign doi: 10.1054/ bjoc.2000.1548, available online at http://www.idealibrary.com on http://www.bjcancer.com abdominal washing, 35 due to resection-line involvement and 3 patients due to positive cytology as well as positive margins. In 5 of the remaining 639 R0 patients, no primary tumour could be found and in one patient the T-stage could not be determined due to inadequate specimen handling. The present report will therefore be based on 633 patients, including 44 patients who died in the post-operative phase (in-hospital death or within 30 days after surgery), since the postoperative mortality was different between the D1 and D2 group (15 versus 29 patients). Survival time was calculated from the date of surgery until death or last follow-up alive. The range in follow-up time of patients still alive was 6.0 to 10.2 years, with a median follow-up of 7.9 years. ClassificationsIn (Table 2). As said before, we had to make additional to the official 1997 TNM definitions, a Nx category and consequently an 'unclassifiable' TNM category for the node-negative patients with <15 lymph nodes examined (TNMx). StatisticsThe χ 2 test was applied to assess differences in the distribution of patients among groups. The Mann-Whitney test was used for comparis...

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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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Prognostic relevance of systematic lymph node dissection in gastric carcinoma

Cited by 446 publications

References 13 publications

Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value

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

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