Volumes of lymphadenectomy in gastric cancer surgery

Abstract

It is summarized an experience of 1528 resections for gastric cancer supplemented by D1-, D2-, D2,5- and D3-lymphadenectomy in 751, 241, 359 and 177 patients resrectively. Unconventional type D2.5 means D2-lymphodis section with additional lymphadenectomy along hepatoduodenal ligament and superior retropancreatic nodes as well as omental bursa removal with lymphodis section of esophageal opening crura. Analysis of immediate and remote results is presented. It is concluded that D3-lymphadenectomy is minimally preferred over D2.5-type in gastric cancer staging. D3-lymphodis section has the largest number of especially purulent and pancreatogenic postoperative complications. D2.5-lymphadenectomy significantly increases 5-year survival in comparison with D2-lymphodis section (from 51.2 ± 4.9 to 64.0 ± 4.1%; p<0.001) and may be chosen for any radical surgery for gastric cancer including early forms. Localized proximal tumors which are in distinctive for metastasis into hepatoduodenal ligament lymph nodes are exception. D3-lymphodis section did not impact on survival in comparison with D2,5-lymphadenectomy. Only patients with antral cancer after distal subtotal gastric resection had 5-year survival increasing on 8 % (from 60.6 ± 7.5 to 68.5 ± 6.3%).