D2 Plus Para-aortic Lymphadenectomy Versus Standardized D2 Lymphadenectomy in Gastric Cancer Surgery

Overview

Journal Surg Today

Specialty General Surgery

Date 2009 Mar 13

PMID 19280279

Citations 20

Authors

Jian-Kun Hu

Kun Yang

Bo Zhang

Xin-Zu Chen

Zhi-Xin Chen

Jia-Ping Chen

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the survival benefits and safety of D2 plus para-aortic lymphadenectomy (D2 + PALD) for gastric carcinoma.

Methods: Patients with gastric carcinoma, who agreed to undergo D2 + PALD between February 2001 and December 2003, were allocated to the D2 + PALD group, and compared with a control group who underwent D2 lymphadenectomy. Patients were followed up until August 2007.

Results: Sixty-two patients were allocated to the D2 + PALD group, and a concurrent 55 patients were allocated to the D2 group. The mean follow-up period was 57.6 (range 43.0-77.6) months, with 11.1% lost to follow-up. The morbidity and mortality rates were 24.2% and 0% in the D2 + PALD group, and 27.3% and 1.8% in the D2 group, respectively. The overall 3- and 5-year survival rates were 77.5% and 65.8% in the D2 + PALD group, and 73.2% and 66.1% in the D2 group, respectively, without a significant difference. The frequency of metastasis to the para-aortic lymph nodes (PALN) was 8.1%. The logistic regression revealed that PALN metastasis was correlated to metastasis of No. 8a and No. 9 lymph nodes (P = 0.021 and P = 0.030, respectively).

Conclusion: Although D2 + PALD can be performed safely with an acceptable incidence of complications when performed by well-trained gastrointestinal surgeons, its survival benefits are not significantly greater than those of D2 lymphadenectomy. Therefore, routine D2 + PALD should not be recommended.

Citing Articles

Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node.

Yao Z, Yang H, Cui M, Xing J, Zhang C, Zhang N Front Oncol. 2023; 13:1131725.

PMID: 36923426 PMC: 10009175. DOI: 10.3389/fonc.2023.1131725.

Current status of extended 'D2 plus' lymphadenectomy in advanced gastric cancer.

Li J, He D, Liang Y Oncol Lett. 2021; 21(6):467.

PMID: 33907577 PMC: 8063322. DOI: 10.3892/ol.2021.12728.

Advances in para-aortic nodal dissection in gastric cancer surgery: A review of research progress over the last decade.

Dong Y, Deng J World J Clin Cases. 2020; 8(13):2703-2716.

PMID: 32742981 PMC: 7360716. DOI: 10.12998/wjcc.v8.i13.2703.

Multimodality management of locally advanced gastric cancer-the timing and extent of surgery.

Stewart C, Chao J, Chen Y, Lin J, Sullivan M, Melstrom L Transl Gastroenterol Hepatol. 2019; 4:42.

PMID: 31231709 PMC: 6556681. DOI: 10.21037/tgh.2019.05.02.

Is There Any Role for D3 Lymphadenectomy in Gastric Cancer?.

Douridas G, Pierrakakis S Front Surg. 2018; 5:27.

PMID: 29740588 PMC: 5931173. DOI: 10.3389/fsurg.2018.00027.

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