Gastrectomy with D2 lymphadenectomy for gastric cancer: Morbidity, mortality and survival

Abstract

Background: Gastric cancer is the second leading cause of cancer death worldwide. Ninety percent of gastric cancers are adenocarcinomas. Overall, there is a decline in the incidence of gastric cancer in most countries over the past 50 years. Surgical resection is the most effective treatment for curable gastric cancer.Controversy still surrounds the value of extensive lymph node dissection in the curative treatment of gastric carcinoma.The overall 5-year survival rate among patients with resectable gastric cancer ranges from 10% to 30% in the western world. In contrast, Japanese publications report a marked improvement in survival (between 50% and 62%), largely attributed to lymph node resection known as D2 lymphadenectomy. Methods: The study was a prospective follow-up study on 50 consecutive patients with gastric cancer (without distant metastasis) between March 2007 and February 2010 in the Upper Gastrointestinal Surgery Unit, Faculty of Medicine, Alexandria University, Egypt. Patients less than 65 years with histologically proven and potentially curable gastric cancer were eligible for the study. Preoperatively, all patients underwent upper gastrointestinal endoscopy with biopsies and histopathologic examination. Computed tomography (CT) scans were done to look for metastases. Results: Fifty patients (36 men, 14 women) underwent gastric resection with D2- lymphadenectomy for gastric adenocarcinoma in a three-year period. Mean age was 46.6 years with a range of23-65 years. Almost 44% of patients had preoperative co-morbid disease. Weight loss with epigastric pain and dyspepsia was the most common presenting symptom (80%). Fifty patients underwent D2 resection, fifteen patients with radical total gastrectomy and intra­ abdominal oesophagojejunostomy, and thirty five patients with a subtotal distal gastrectomy and gastrojejunostomy. The hospital mortality rate was 4% (2/50). Morbidity rate was 44% (22/50), some of them presented with more than one complication. The median time of hospital stay was 22 days (mean 22.3, range 13-40). Follow-up included clinical, laboratory and CT examinations of all patients after surgery. In addition, when relapse was suspected, endoscopy with biopsy, and CT scan were performed. During the first 2 years follow-up, locoregional relapses were observed in 2 patients (local lymph nodes relapse). One patient presented with peritoneal recurrence, and 2 patients showed distant spread. The overall actuarial one-year survival in D2 patients was 92% and 76% at two years. Conclusion: The results obtained in our series of patients submitted to gastrectomy with D2 lymphadenectomy suggest that this technique offers low morbidity, mortality and acceptable 2-year survival rates. The survival benefit with D2 is obtained when a tumor invades muscularis propria or penetrates serosa without invasion of adjacent structures.