Survival outcomes after D1 and D2 lymphadenectomy with R0 resection in stage II–III gastric cancer: Longitudinal follow-up in a single center
Adam Uslu , Baha Zengel , Enver İlhan , Ahmet Aykas , Cenk Şimşek , Orhan Üreyen , Ali Duran , Gökalp Okut
Department of General Surgery, University of Health Sciences, Izmir Bozyaka Research and Training Hospital, İzmir, Turkey
Keywords: R0 resection, D1 lymph node dissection, D2 lymph node dissection, total gastrectomy
Objective: D2 lymphadenectomy (D2-LND) with curative resection (R0) is the cornerstone of gastric cancer treatment. In this study, we compared survival outcomes of D2-LDN with D1-LDN in patients who had undergone curative resection for Stages II and III primary gastric adenocarcinoma.
Material and Methods: Between April 1996 and March 2014, 153 consecutive patients with adenocarcinoma of the stomach underwent total gastrectomy with D1-LND or D2-LND. Among those, 118 patients (38 D1 vs. 80 D2) with a complete history and having been followed for at least 1 year after surgery were enrolled.Both groups were compared in terms of demographic and clinico-pathologic characteristics.
Results: The mean follow-up was 42.6±52.5 months (mo.). The demographic characteristics of the groups were similar. The Tumor, Node and Metastases (TNM) stage distribution was 25% for Stage II and 75% for Stage III for both groups. Eighteen patients (47.4%) in the D1 and 47 patients (58.8%) in the D2 group were free from locoregional recurrence. The median disease-free survival was 22.0±4.1 mo. for the D1 and 28.0±4.3 mo. for the D2 group (p=0.36). Eight patients (21%) in the D1 and 39 patients (49%) in the D2 group were alive at the last follow-up. The median overall survival (OS) was 22.0±3.7 mo. for the D1 and 31.0±5.4 mo. for the D2 group (p=0.13). The 5-yeardisease-free survival and OS by the Kaplan–Meier estimates were 41% vs. 51% and 30% vs.42% in the D1 and D2 groups, respectively. The median 5-year OS for patients with Stages IIIB and IIIC tumors was 14.0±2.2 mo.for the D1 and 20.0±5.0 mo. for the D2 group, respectively (p: 0.048).
Conclusion: When compared to D1-LND, D2-LND with R0 resection have yielded a trend toward a better outcome in patients with primary gastric adenocarcinoma.
Cite this paper as: Uslu A, Zengel B, İlhan E, Aykas A, Şimşek C, Üreyen O, Duran A, Okut G. Survival outcomes after D1 and D2 limphadenectomy with R0 resection in stage II–III gastric cancer: longitudinal follow-up in a single center. Turk J Surg 2018; 34: 125-130.
Authors declared that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects” (amended in October 2013).
Written informed consent was obtained from patients who participated in this study.
Concept - A.U., B. Z.,; Design - A.U.; Supervision - B. Z., E.I., A.A.; Resource A.U., B.Z., E.I., A.A.; Materials - A.U., B.Z., E.I.; Data Collection and/or Processing - B.Z., E.İ., A.A., O.U.; Analysis and/orInterpretation - A.A., O.U., C.S., A.D., G.O.; Literature Search - B.Z., E.I., C.S., O.U.; Writing Manuscript - A.U., B.Z., A.D., G.O.; Critical Reviews - E.I., A.A.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.
We would like to thank Raika Durusoy, from Department of Public Health, Ege University School of Medicine for statistical analysis.