Abstract
This study was conducted to investigate prognosis and survival of patients undergoing distal subtotal gastrectomy with D2 and D2+ lymphadenectomy for patients with locally advanced gastric cancer. Overall survival rates of 416 patients with locally advanced gastric cancer were compared between D2 and D2+ lymphadenectomy. Univariate analysis and multivariate analysis was used to identify significant prognostic factors correlated with LN metastasis and prognosis. Univariate analysis identified tumor size, lymphatic vessel invasion, pT stage, pN stage, TNM stage, locoregional recurrence, and distant recurrence, to significantly correlate with prognosis; Tumor size, LVI, and pT stage were identified as independent factors correlating with LN metastasis. Multivariate analysis demonstrated that tumor size, pT stage, pN stage, locoregional recurrence, and distant recurrence were independent prognostic factors; Tumor size and pT stage were independent prognostic factors predicting LN metastasis. When comparing 5-year survival rates of patients who underwent D2 and D2+ lymphadenectomy, as stratified by pT stage and pN stage, a significant difference was found in pN3 patients, but not for pT2–4 and pN0–2 patients, or the patient cohort as a whole. In conclusion, D2 lymphadenectomy for patients with locally advanced gastric cancer undergoing distal subtotal gastrectomy was recommended, especially in eastern Asia.
Highlights
Standard D2 lymphadenectomy has become the standard treatment for curable gastric cancer in eastern Asia, especially in Japan and China
Extended D2 (D2+ ) lymphadenectomy may help to retrieve more LNs for patients with gastric cancer compared with D2 lymphadenectomy, which may contribute to adequate staging and a beneficial survival outcome
A total of 416 patients with locally advanced gastric cancer who underwent distal subtotal gastrectomy were included in this study
Summary
A more extensive LN dissection may contribute to more LNs retrieved, which may improve staging accuracy. Gastrectomy with D1 or modified D2 lymphadenectomy, with a goal of ≥ 15 LNs retrieved has been recommended for patients with localized resected gastric cancer in western countries[7,11,15]. Previous studies have shown that a more extensive LN dissection improves survival in patients with advanced gastric cancer[11,12,16]. Extended D2 (D2+ ) lymphadenectomy may help to retrieve more LNs for patients with gastric cancer compared with D2 lymphadenectomy, which may contribute to adequate staging and a beneficial survival outcome. There is no study comparing survival after D2 and D2+ lymphadenectomy for locally advanced gastric cancer with distal subtotal gastrectomy. In light of these considerations, we aimed to investigate prognosis and survival of patients undergoing distal subtotal gastrectomy with D2 and D2+ lymphadenectomy for patients with locally advanced gastric cancer
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