Abstract
The impact of lymphadenectomy in the surgical treatment of carcinoma of the upper gastrointestinal tract remains controversial. Eastern, especially Japanese centers advocate extended forms of lymphadenectomy on the basis of their excellent results, whereas many Western authors state that its benefits do not outweigh the risks of higher operative morbidity and mortality. In our department we have been favoring systematic lymphadenectomy in gastrointestinal surgery of malignant tumors since 1978. Out of 1,500 subtotal and total gastrectomies, which have been performed in our department since 1968, there were 440 resections with a D2 lymphadenectomy in patients with gastric carcinoma between 1986 and 1994. Lymphadenectomy resulted in a specific morbidity of 3.6%. As compared to the era before systematic lymphadenectomy was performed, patient survival improved especially in UICC stage II and IIIA with reduced morbidity. On the background of this evaluation, our therapeutic concept for the treatment of gastric cancer with special regard to the extent of lymphadenectomy is presented.
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